Snider v. Quantum Health

NOTICE OF CONSENT TO BE A PARTY PLAINTIFF

Fair Labor Standards Act of 1938, 29 U.S.C. 216(b)

I consent to be a party plaintiff to seek unpaid wages and overtime pay in the case in which this consent is filed (Snider v. Quantum Health, Inc.). By joining this lawsuit, I designate the named plaintiff(s) of the case in which this consent is filed, and his/her attorneys (and other persons those individuals designate as necessary) as my representatives to make all decisions on my behalf, to the extent permitted by law, concerning the method and manner of conducting the case including settlement, the entering of an agreement with Plaintiff’s counsel regarding payment of attorneys’ fees and court costs, and all other matters pertaining to this lawsuit. For purposes of pursuing my unpaid wage and overtime claims I choose to be represented by The Hedgpeth Law Firm, PC, The Siegel Law Group PLLC, and other attorneys with whom they may associate.

Name*

First Name

Last Name

I agree to use electronic records and signatures.

Please read the Electronic Signature Disclosure at https://www.collectiveaction.io/termsofuse/

Signature*

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This information will not be part of the Public Record and is only necessary for your Attorneys’ Files and Potential Settlement Purposes.

***Note: This Portion Will NOT Be Filed with the Court***

Cell Phone Number

Home Phone Number

Address*

Address Line 1

Address Line 2

City

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ZIP Code

Email*

Locations where you worked: *

Position(s) you held: *

Approximate dates of employment:*