Employment

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Practice Areas

Northern California Call
Toll Free 866-570-7808
Local 916-993-5009

We represent clients throughout Sacramento and Fairfield as well as the entire Bay Area, including Berkeley, San Francisco, Burlingame, Alameda County, Daly City, Fremont, Oakland, San Mateo, and Redwood City.

Attorney Wendy C. York

Potential Employment Client Questionnaire

Please bear in mind, that if you have time deadlines (or statute of limitations) that are quickly approaching, we cannot guarantee that we will respond in time for us to assist you in filing a lawsuit. You should take immediate action.

Contact Information

* Name:
* Street:
* City:
* State:
* Zip:
* Phone:
Other Phone:
* Email:

* How did you hear about us?
1. Yellow Pages
2. Internet/Search Engine
3. Findlaw
4. Other
Another attorney:

Employment Information

* 1. Name of employer you wish to seek legal action against:
* 2. Address of employer:
* 3. Approximate number of employees that are employed in California?
* 4. Your most current position:
* 5. Your current rate of pay and estimated yearly income:
* 6. Number of years you were employed with employer
* 7. Were you terminated, did you resign, or are you still employed?
1. Terminated
2. Resigned
3. Still Employed
7a. If you were terminated, please state the reason the employer gave you for terminating you?
* 8. If you were terminated or resigned state the date of your termination/resignation?
* 9. Do you believe that your treatment at work was motivated by discrimination?
1. Yes
2. No
9a. If so, on what basis? (check all that apply)
1. Race
2. Gender / Sex
3. Age (over 40)
4. Sexual Harassment
5. National Origin
6. Sexual Orientation
7. Religion
8. Pregnancy
9. Disability / Medical Condition
10. Marital Status
11. Other
* 10. When did the last discriminatory event take place (exact date)?
10a. Has it been more than one year since the last event?
1. Yes
2. No
11. Were discriminatory comments made about your: (check all that apply)
1. Race
2. Gender / Sex
3. Age (over 40)
4. Sexual Harassment
5. National Origin
6. Sexual Orientation
7. Religion
8. Pregnancy
9. Disability / Medical Condition
10. Marital Status
11. Other
12. Were people who were (different race, the opposite sex, younger, different sexual orientation, or of a different religion) treated more favorably?
1. Yes
2. No
* 13. Did you report or blow the whistle on any unlawful or fradulent conduct occurring in the workplace?
1. Yes
2. No
13a. If so, please provide a brief description of the details:
14. Do you believe that you were retaliated against for complaining about discrimination or for complaining about some unlawful activity at the workplace? If so, please provide details (exactly, what did you complain about)?
* 15. Did you complain about discrimination or retaliation?
1. Yes
2. No
* 16. Did you complain in writing or verbablly?
1. In writing
2. Verbally
* 17. Who did you complain to?
1. Supervisor
2. Manager
3. Human Resources
4. Director
5. President
6. Outside government agency
7. Other:
18. What was the response of the employer when you complained? (check all that apply)
1. Investigation
2. Retaliation
3. Disciplinary action against you
4. No Action
5. Demotion
6. Low performance review
7. Other:
19. Do you have any witnesses or documents that help prove your claim? If so, describe:

* 20. Please check the description that would best describe your performance evaluations for the last five years?

Personal Information

* 21. Have you recently had to seek any kind of outside medical assistance or consultation as a result of work-related stress or problems at work? (check all that apply)
1. Emergency medical
2. General medical
3. Psychological
4. Psychiatric
5. Other Counseling
6. None
21a. If you have sought outside medical assistance or consultation please describe the circumstances (e.g., anxiety, depression, ulcers, high blood pressure, chest pain, counseling, etc.)
22. Have you filed a complaint with any outside governmental agency? (check all that apply)
1. Department of Fair Employment & Housing (DFEH)
2. Equal Employment Oppoirtunity Commission (EEOC)
3. Other
23. If you have filed a complain with an outside agency, what is the status of your filing (i.e., under investigation, right-to-sue letter issued, etc.)?
24. Have you filed any lawsuits in the past?
1. Yes
2. No
If so, what type, and how many?
* 25. Have you ever been convicted of a felony?
1. Yes
2. No
* 26. Have you declared bankruptcy in the last 5 years?
1. Yes
2. No
27. Please use the following space to describe any other events at your place of employment (that have not been discussed above) that caused you to seek legal actions. Please provide dates when discussing employer conduct.

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Sacramento Office

1111 Exposition Boulevard
Building 500
Sacramento, CA 95815
Find us on Google Maps

Telephone 866-570-7808
Local 916-993-5009
Facsimilie 916-643-4680

Fairfield Office

1652 West Texas Street
Suite 248
Fairfield, CA 94533

Telephone 707-207-6770

© 2008 York Law Corporation | Sacramento, CA 866-570-7808| Local 916-993-5009 | Fairfield, CA 707-207-6770

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Practice Areas

Northern California Call Toll Free 866-570-7808 Local 916-993-5009

Attorney Wendy C. York

Potential Employment Client Questionnaire

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Sacramento Office

Fairfield Office

Northern California Call
Toll Free 866-570-7808
Local 916-993-5009