Free Affidavit - District Court of California - California

Case 4:07-cv-02828-CW

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 CONSENT TO JOIN SETTLEMENT AND CLAIM FORM Case No. C 07 2828 CW
LA1 6686133.1

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF CALIFORNIA LINDA YOUNG and MIKE SAFAIE, individually and on behalf of all others similarly situated, Plaintiff, vs. CHARLES SCHWAB & CO., INC. Defendant. Case No. C 07 2828 CW CONSENT TO JOIN AND CLAIM FORM

IF YOU WANT TO PARTICIPATE IN THE SETTLEMENT WITH RESPECT TO THE FAIR LABOR STANDARDS ACT CLAIM AND RECEIVE YOUR SHARE OF THIS SETTLEMENT, COMPLETE THIS FORM IN ITS ENTIRETY, SIGN THE FORM AND RETURN IT TO THE ADDRESS BELOW, POSTMARKED ON OR BEFORE [90 DAYS AFTER MAILING OF NOTICE] Schwab Claims Administrator Rust Consulting Inc. 625 Marquette Avenue, Suite 880 Minneapolis, MN 55402-2469 YOUR PARTICIPATION IN THE SETTLEMENT WILL HAVE NO EFFECT ON YOUR EMPLOYMENT WITH SCHWAB

Case 4:07-cv-02828-CW

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I declare as follows: (1) I received notice the Notice of Pendency of Class Action and I wish to receive my

share of the proposed Settlement. (2) During all or part of the applicable period set forth in Exhibit A of the Notice of

Pendency of Class Action, I was employed by Charles Schwab & Co., Inc. ("Schwab") as a Branch Client Service Specialist I and/or Branch Client Service Specialist II and/or in a nonexempt client service specialist role in the following state(s) and or territories: _____________. (3) Please check only one: I agree with Schwab's records that I worked a total of _____ full or partial weeks as a Branch Client Service Specialist I and/or Branch Client Service Specialist II and/or in a non-exempt client service specialist role during the applicable time period(s) for the state(s) and/or territories in which I was employed. I disagree with Schwab's records and instead contend that I worked a total of ______ full or partial weeks as a Branch Client Service Specialist I and/or Branch Client Service Specialist II and/or in a non-exempt client service specialist role during the applicable time period(s) for the state(s)and/or territories in which I was employed.

2 CONSENT TO JOINT SETTLEMENT Case No. C 07 2828 CW
LA1 6686133.1

Case 4:07-cv-02828-CW

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Further, I consent to join the Linda Young, et al. v. Charles Schwab & Co., Inc. action pursuant to the Fair Labor Standards Act.

Executed on _________, 2008, at ____________, ___________________. (city) (state) _____________________________________ (Signature) _____________________________________ [Printed Name to be inserted prior to mailing by Rust Consulting.]

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[This page and cover page to be filed with court only]

3 CONSENT TO JOINT SETTLEMENT Case No. C 07 2828 CW
LA1 6686133.1