Case Evaluation

Name

Phone

Email Address

Street

City

State

Zip Code

Are you an Employee or an Employer? Are you an Employee or an Employer? Employee Employer

Are you still working for the Employer? Are you still working for the Employer? Yes No

What is/was your job position?

What was your most recent compensation? (salary, bonus, commissions, etc.)

Employer Name

Employer Street Address

Employer City

Employer State

Employer Zip

Employer Size? (by number of employees) Employer Size? (by number of employees) less than 15 15-49 50-99 100-199 200-299 300 or more

What is the nature of your legal matter? Select all that apply. What is the nature of your legal matter? Select all that apply. Sexual Harrassment Gender Discrimination Race or National Origin Discrimination Age Discrimination Religious Discrimination FMLA Discrimination Retaliation Wage and Hour Claim Whistleblower Other

Actions Take Against You (check all that apply) Actions Take Against You (check all that apply) Fired Demoted Denied Promotion Refused to Hire Other

Did your employer give you a reason for the action they took against you? Did your employer give you a reason for the action they took against you? yes no

What reasons were given?

Most recent date you were subjected to the illegal conduct?

Have you ever complained to the employer about the illegal conduct you are contacting me about? Have you ever complained to the employer about the illegal conduct you are contacting me about? yes no

Are you aware of other current or former employees at your employer that have experienced the same kind of discrimination or illegal conduct? Are you aware of other current or former employees at your employer that have experienced the same kind of discrimination or illegal conduct? yes no

Have you filed an EEOC charge or lawsuit related to the illegal conduct you experienced? Have you filed an EEOC charge or lawsuit related to the illegal conduct you experienced? yes no

Case Summary