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Register Interest Merivale

Am I Eligible?

Thank you for registering your expression of interest in the merivale class action.
Please fill out the short questionnaire below.

Step 1 of 3

33%

Name*
Prefix First Middle Last
Phone*
Please enter with country code format, for example if entering a mobile number please enter it as +61xxxxxxxxx by dropping the first 0 of the mobile number or area code.
Email*
Enter Email Confirm Email
Address*
Street Address City State / Province / Region Post Code Country
Date Of Birth*
Date Format: DD slash MM slash YYYY
Were you employed by M.R.V.L Investments Pty Ltd (Merivale) to work in a hospitality or restaurant role within the last 6 years?*
- Yes
- No

During your employment with Merivale what positions did you work in?*
Were any of these positions at Merivale salaried?*
- Yes
- No
During your employment with Merivale were you paid for every hour that you worked?*
- Yes
- No
During your employment with Merivale do you believe that every hour you worked was captured via the “thumb in/thumb out” system?*
- Yes
- No
If no, please detail*
During your employment Merivale were you paid for attending compulsory training and/or meetings?*
- Yes
- No
During your employment with Merivale do you recall ever being told that you were paid above Award wages?*
- Yes
- No
If yes, please enter the name or title of the person who communicated this to you and when*
During your employment with Merivale were you ever reprimanded for refusing to work a shift?*
- Yes
- No
If yes, please detail each occurance*
During your time at Merivale, how many venues did you work at?*
Only include venues you worked at during the past 10 years
Which venues did you work at?*
Start Date (approx)*
Date Format: DD slash MM slash YYYY
End Date (approx)*
Date Format: DD slash MM slash YYYY
Which venues did you work at? (2)*
Start Date (approx)*
Date Format: DD slash MM slash YYYY
End Date (approx)*
Date Format: DD slash MM slash YYYY
Which venues did you work at? (3)*
Start Date (approx)*
Date Format: DD slash MM slash YYYY
End Date (approx)*
Date Format: DD slash MM slash YYYY
Which venues did you work at? (4)*
Start Date (approx)*
Date Format: DD slash MM slash YYYY
End Date (approx)*
Date Format: DD slash MM slash YYYY
Which venues did you work at? (5)*
Start Date (approx)*
Date Format: DD slash MM slash YYYY
End Date (approx)*
Date Format: DD slash MM slash YYYY
Which venues did you work at? (6)*
Start Date (approx)*
Date Format: DD slash MM slash YYYY
End Date (approx)*
Date Format: DD slash MM slash YYYY
Which venues did you work at? (7)*
Start Date (approx)*
Date Format: DD slash MM slash YYYY
End Date (approx)*
Date Format: DD slash MM slash YYYY
Which venues did you work at? (8)*
Start Date (approx)*
Date Format: DD slash MM slash YYYY
End Date (approx)*
Date Format: DD slash MM slash YYYY
Which venues did you work at? (9)*
Start Date (approx)*
Date Format: DD slash MM slash YYYY
End Date (approx)*
Date Format: DD slash MM slash YYYY
Which venues did you work at? (10)*
Start Date (approx)*
Date Format: DD slash MM slash YYYY
End Date (approx)*
Date Format: DD slash MM slash YYYY

Disclosure Letter

By signing below and submitting this form you:
- reasonably believe that you will be eligible to participate in the action;
- warrant that;
  - the information you have provided is true and correct; and
  - you will not sign-up or register using any false or misleading details;
- hereby execute and agree to be bound by and comply with the terms of the;
  - Retainer Agreement
  - have been given the opportunity to obtain independent legal advice as to the nature and effect of the Retainer Agreement and you agree to be bound and comply with the terms of our Retainer Agreement;
    - after obtaining, and in reliance on such independent legal advice; or
    - having elected not to obtain independent legal advice; and
      - you have read and understood the nature and effect of our Retainer; and
      - you do not require any explanation or advice in relation to those documents;
      - consent and authorise us to use the information provided to assess whether or not you may be eligible to participate in the action; and
      - consent to receive further communications from us regarding any continued participation in the action.
    - Signature*
    - Consent*
      I agree to the terms and conditions.
      By submitting this form you:
      
      Reasonably believe that you will be eligible to participate in the action;
      
      Warrant that: the information you have provided is true and correct; and you will not sign-up or register using any false or misleading details;
      
      Consent and authorise us to use the information provided to assess whether or not you may be eligible to participate in the action; and Consent to receive further communications from us regarding any continued participation in the action
    - *
      I understand that the retainer and the disclosure letter are confidential documents. I understand that I am not permitted to share these documents or the information contained therein with any third party or for any purpose other than participating in the proposed proceedings.
    - If you would prefer to sign a hard copy of this agreement, please print out a copy of the Retainer Agreement, complete the Claimant Details in the document, sign it, and then scan it as a PDF and email it to: merivale@aderolaw.com.au

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