Employment Law Client Intake Form

"*" indicates required fields

Name*

Your Email*

Cell Phone Number*

How did you hear about us?*

Name of the Your Current or Last Employer.*

How long have you worked at employer business?*

Tell us about your employment history as an adult, provide a brief chronology of all the places you have been employed since High School or college and list the approximate dates employed with each employer and your job titles with each employer.

What was your last job title with employer.*

Name of your immediate Supervisor*

Names and titles of all the people you claim have wronged you.

Are you a Union member; if so, what union?*

Have you reported your complaints and concerns to your supervisor(s) or union? If so, what did you report, when did you report it and to whom? What response did you receive?

When was your last performance evaluation? What kind of evaluation did you receive?

Do you have any disciplinary actions against you or corrective actions or performance plans with this employer or any other employer in the past? *

Have you ever filed a lawsuit in the past? if so, please explain.

Have you been fired, separated or terminated from employment? If so, please explain. *

If you have been fired, separated or terminated from employment, what reason did your employer give you for the action?

What do you think is the real reason for the adverse employment action against you?

Have you filed a claim for unemployment insurance? Has your claim been approved? If your claim has been denied, what reason was given to you for the denial of your claim?

Please explain the facts and circumstances that have led you to contact us.

Please upload any relevant file/documents

Max. file size: 50 MB.