Legal Collective Action Consent Form

LEGAL COLLECTIVE ACTION CONSENT FORM

This Consent Form is entered into between Claimant Name: (hereinafter "Claimant") and Plaintiffs' Counsel/Firm Name: (hereinafter "Counsel") as of the date signed below.

RECITALS

WHEREAS, Claimant has asserted or may assert claims arising from employment practices, wage and hour matters, or other claims of a substantially similar nature that are the subject of a proposed collective action in the action captioned Case Name: , pending in Court: , Docket No.: .

WHEREAS, Counsel is acting or intends to act as counsel for the representative plaintiffs and collectively on behalf of similarly situated persons in the collective action and is prepared to prosecute the claims described above on behalf of Claimant subject to the terms of this Consent Form.

WHEREAS, Claimant desires to join the collective action and to authorize Counsel to represent Claimant in connection with the collective claims described in this Consent Form on the terms set forth below.

NOW, THEREFORE, in consideration of the mutual promises set forth below, the parties agree as follows:

1. CONSENT TO JOIN AND SCOPE OF CONSENT

1.1 Claimant hereby knowingly and voluntarily consents to join and participate in the collective action identified above and grants Counsel the authority to file, prosecute, amend, and pursue Claimant's claims that are consistent with the claims asserted in the collective action. Claimant understands that this consent authorizes Counsel to include Claimant as a member of any collective or representative group and to pursue relief on Claimant's behalf.

1.2 Claimant's consent is limited to claims based on substantially similar factual and legal theories as those asserted in the collective action, and does not automatically extend to unrelated claims unless expressly agreed in writing.

2. SCOPE OF REPRESENTATION; AUTHORITY

2.1 Counsel shall have authority to take procedural and substantive actions on behalf of Claimant reasonably necessary to prosecute the collective action, including but not limited to: filing pleadings, conducting discovery, issuing subpoenas, negotiating settlements, and appearing in court. Counsel shall keep Claimant reasonably informed of material developments.

2.2 Claimant authorizes Counsel to request and obtain documents and information from third parties and Claimant's employers and to execute such disclosures and authorizations reasonably necessary for prosecution of the claims. Claimant represents that the information provided to Counsel is true and complete to the best of Claimant's knowledge.

3. FEES AND COSTS

3.1 Claimant agrees that Counsel will be compensated in accordance with the contingency fee arrangement or common fund allocation established for the collective action. Unless otherwise specified in a separate written agreement, Claimant acknowledges and agrees that Counsel's fees and litigation costs may be paid from any recovery obtained on Claimant's behalf, in proportions determined by the court or by agreement among counsel and claimants.

3.2 Counsel shall seek court approval for any proposed fee and cost allocation. Claimant acknowledges that any fee award determined by the court may reduce Claimant's recovery.

4. RELEASES; SETTLEMENT AUTHORITY

4.1 Claimant understands that any settlement reached in the collective action that would release Claimant's claims requires either court approval or Claimant's express written consent as provided by the court's procedures. Subject to applicable court procedures, Claimant authorizes Counsel to negotiate settlements on Claimant's behalf and to execute settlement documents that are consistent with the settlement terms approved by Claimant.

4.2 Claimant acknowledges that in the event of a settlement, Claimant may be required to execute a release of claims and other documents necessary to effectuate the settlement, and Claimant agrees to cooperate reasonably in connection with any settlement administration.

5. AUTHORIZATION FOR RELEASE OF INFORMATION

Claimant authorizes current and former employers, payroll processors, healthcare providers, government agencies, and other custodians of records to disclose Claimant's personnel, payroll, timekeeping, benefits, and other records and information reasonably necessary to prosecute Claimant's claims to Counsel and to the extent necessary in the collective action. Claimant agrees that copies of such authorizations may be used in place of originals.

6. CONFIDENTIALITY AND PRIVILEGE

All communications between Claimant and Counsel made for the purpose of obtaining or providing legal advice are confidential to the extent permitted by law. Counsel will assert applicable privileges and protections for confidential communications and records, except where Claimant expressly authorizes disclosure or the court orders otherwise.

7. WITHDRAWAL; OPT-OUT

7.1 Claimant may withdraw this consent or opt out of the collective action in accordance with any deadlines or procedures established by the court. Withdrawal or opt-out does not relieve Claimant of obligations incurred prior to withdrawal, including obligations for fees or costs previously advanced or agreed upon.

7.2 If Claimant elects to pursue separate litigation after withdrawing, Claimant understands Claimant must retain separate counsel and that Counsel's representation of the collective group does not create an obligation to represent Claimant in separate proceedings.

8. NOTICES

9. REPRESENTATIONS AND CERTIFICATIONS

Claimant represents and warrants that Claimant is the individual identified herein, that Claimant has authority to authorize the release of records described in this Consent Form, that the statements made to Counsel are true and complete to the best of Claimant's knowledge, and that Claimant has not previously released the claims being asserted in a manner that would preclude participation in the collective action.

10. AMENDMENTS; WAIVER

This Consent Form may be amended only by a writing signed by Claimant and Counsel. No waiver by any party of breach of any provision of this Consent Form shall be deemed a waiver of any other breach, nor shall any waiver constitute a continuing waiver.

11. GOVERNING LAW; VENUE

This Consent Form shall be governed by and construed in accordance with the substantive law of the jurisdiction in which the collective action is filed, without regard to its conflict of laws principles. Claimant and Counsel submit to the jurisdiction and venue of the court in which the collective action is pending for any disputes arising under this Consent Form.

12. ENTIRE AGREEMENT; SEVERABILITY; COUNTERPARTS

This Consent Form constitutes the entire agreement between Claimant and Counsel with respect to Claimant's participation in the collective action, supersedes any prior agreements or understandings, and may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument. If any provision of this Consent Form is determined to be invalid or unenforceable, the remainder of the Consent Form shall remain in full force and effect.

CERTIFICATION

Claimant certifies under penalty of perjury that the information provided in this Consent Form is true and correct to the best of Claimant's knowledge and that Claimant has read and understands the terms of this Consent Form.

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