November 2014
FLSA Questionnaire for Non-Exempt Employees
1) Describe how the employee records his/her hours worked (timesheets, time clock, etc.)
__________________________________________________________________________
2) What is your regularly scheduled work shift? (specify days of the week and hours scheduled)
__________________________________________________________________________
3) How are meal breaks documented/recorded?
__________________________________________________________________________
4) If your meal break is interrupted, how does your department document/record if this occurs?
__________________________________________________________________________
5) Have you ever received overtime or compensatory time from the City of Little Rock?
__________________________________________________________________________
6) Do you drive a City vehicle?
□ Yes □ No
6b) If yes, do you ever have to drive your City vehicle before or after your shift?
__________________________________________________________________________
7) Do you ever have to respond to phone calls or e-mails for City business outside of your regularly
scheduled work shift? If yes, please specify how this is documented/recorded.
__________________________________________________________________________
8) Have you ever had to travel to attend training?
□ Yes □ No
8b) If yes, did you travel outside of your regularly scheduled work shift?
__________________________________________________________________________
_________________________________________ ___________________ _______________
Employee Name (Printed) Employee ID # Date
_________________________________________ _______________
Employee Signature Date
_________________________________________ _______________
Supervisor Signature Date
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
