Contact Us
Employment Law Case Evaluation Form
*Name:
*Address:
*City:
*State:
*Zip:
*E-mail address:
*Home Phone:
Business Phone:
Cellular or Pager:
Facsimile:
Please provide the name and address of the employer involved:
Are you a current
of this employer?
Are you presently employed?
If yes, please provide your job title and employer's name and address.
Can you be contacted at work?
Describe your situation, including any relevant dates:
Are you a union member?
If yes, provide the name, address, and local number:
Have you made a complaint about your situation to any governmental agency?
If yes, provide the name of the agency, the date you made your complaint, and
the final result, if any, of your complaint:
Are any other people involved?
If yes, provide names, addresses (if known), and their relationship to you, if
any:
Do you have any documents that could help explain your situation?
If yes, list those documents and their dates:
Are there other documents that you do not have access to that could be of
assistance?
If yes, list those documents and their dates and locations (if known):
Describe how this situation has impacted you:
Describe what you would like to happen to resolve your issue (your preferred
outcome):
Have other attorneys worked on this matter?
If yes, provide names, addresses, and a brief description of their involvement:
Special concerns:
Where did you hear about this website?
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