800.209.2608


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800.209.2608


Tough, Aggressive, and Vigorous

Employment Law Litigation

Tough, Aggressive, and Vigorous


Employment Law Litigation


Call Today: 800-209-2608

Information Questionnaire

Please complete the following questionnaire so we may have a better understanding of your specific case.

General Information

Kindly state your name, address, phone number and email address:





What is your level of education?
High school
Bachelors
Masters
Above Masters

Employee Classification

Are you a federal employee?
Yes
No

Are you a state, county or city employee?
Yes
No

Do you work for a private company?
Yes
No



How long were you employed by the company?
Less than 1 year
1-2 years
2-5 years
More than 5 years

If unemployed how long have you been unemployed?
Less than 1 year
1-3 years
3-6 years
More than 6 years

What was your salary at present/time of termination?
Less than 40K
40K-70K
70K-100K
More than 100K

Events

Pending Action

Do you have a case right now pending before an Administrative Law Judge?
Yes
No

Do you have a case right now pending before a Federal Court?
Yes
No

Do you have a case right now pending before a State Court?
Yes
No

Unpaid Wages

Does your case involve unpaid wages?
Yes
No

Does your case involve unpaid bonuses?
Yes
No

Does your case involve unpaid sales commissions?
Yes
No

Does your case involve unpaid overtime?
Yes
No

Wrongful Termination

Does your case involve a wrongful termination?
Yes
No

Does your case involve a wrongful demotion?
Yes
No

Does your case involve a wrongful suspension?
Yes
No

Does your case involve the taking away of meaningful work assignments?
Yes
No

Discrimination

If you believe discrimination was a factor, please state what you believe the discrimination taken against you was based upon.
Race
National Origin
Age
Gender
Religion
Disability
Other

Disability





Whistle blowing

Do you work at a bank or other financial institution?
Yes
No

Did you report unlawful or fraudulent activity to a party outside of your company?
Yes
No

Do you believe your employer retaliated against you for complaining about discrimination based upon race, gender, age, disability, national origin or religion?
Yes
No

If you're a Federal employee, did you report unlawful or fraudulent activity to someone you wouldn’t ordinarily report to in the course of carrying out your duties?
Yes
No

Did you file a complaint with an outside agency (Dept Labor/EEOC/IRS/DSS)?
Yes
No

Sexual Harassment

Does your case involve sexual harassment by a supervisor?
Yes
No

Does your case involve sexual harassment by a co-worker?
Yes
No

Did you complain to anyone at the company about the sexual harassment you sustained?
Yes
No

Were you sexually assaulted?
Yes
No

Are there any witnesses who personally observed the sexual harassment?
Yes
No

Did the sexual harassment involve more than one incident?
Yes
No

Did you complain to the EEOC or other similar institution?
Yes
No

Did the person who harassed you ever sexually harass anyone else?
Yes
No


Form Submission

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

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