Call Now to Schedule Your Consultation
Please complete the following questionnaire so we may have a better understanding of your specific case.
Kindly state your name, address, phone number and email address:
What is your level of education? High school Bachelors Masters Above Masters
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
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
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
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
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
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
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
If you're human leave this blank:
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.