Employment Law 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.

Note: Fields marked with an asterisk ( * ) are required.

    YOUR CONTACT INFORMATION
  • Yellow PagesInternet/Search EngineFindlawOther
  • EMPLOYMENT INFORMATION
  • TerminatedResignedStill Employed
  • YesNo
  • RaceGender / SexAge (over 40)Sexual HarassmentNational OriginSexual OrientationReligionPregnancyDisability / Medical ConditionMarital StatusOther
  • YesNo
    RaceGender / SexAge (over 40)Sexual HarassmentNational OriginSexual OrientationReligionPregnancyDisability / Medical ConditionMarital StatusOther
  • YesNo
    YesNo
  • YesNo
    In writingVerbally
  • SupervisorManagerHuman ResourcesDirectorPresidentOutside government agencyOther
  • InvestigationRetaliationDisciplinary action against youNo ActionDemotionLow performance reviewOther

  • This Year:    BelowMeetsExceeds
    1 Year Ago: BelowMeetsExceeds
    2 Year Ago: BelowMeetsExceeds
    3 Year Ago: BelowMeetsExceeds
    4 Year Ago: BelowMeetsExceeds
    5 Year Ago: BelowMeetsExceeds
  • PERSONAL INFORMATION
  • Emergency medicalGeneral medicalPsychologicalPsychiatricOther CounselingNone
  • Department of Fair Employment & Housing (DFEH)Equal Employment Oppoirtunity Commission (EEOC)Other
  • YesNo
  • YesNo
     

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.