Join as Class Member — FCA Class Action Lawsuit

Please fill out this form. If something does not apply to you, please type "N/A". You can also leave a comment at the bottom. After filling out the form, please also send us your PLM reviews for the relevant years via email, fax, or mail. Please note: all information is strictly confidential.

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender

Race

Birthday

Education

Job Classification (i.e. Professional, Mid-Level Professional, Senior Professional, Senior Manager)

Date of Hire

Termination Date (if applicable)

2014 PLM Score (if applicable)

2015 PLM Score (if applicable)

2016 PLM SCore (if applicable)

2017 PLM Score (if applicable)

2018 PLM Score (if applicable)

Salary

Location

If you worked in different plants during the years of 2014, 2015, and/or 2016, please separate with a comma and the related estimated dates.

Additional Relevant Information