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* First Name
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* Last Name
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Name of Employer
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Location You Worked
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Address
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City
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State
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Zip Code
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Approximate Number of Employees
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Your position and general job duties/responsibilities
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Dates of Employment
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* Please provide a summary of why you are seeking legal representation. It is important that you are detailed about what happened to you. Most people find it helpful to create a timeline of events beginning with when the issue began and up through the most recent events.
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Were you offered a severance?
Do you have a written employment contract?
Have you filed any complaints or charges with any government agencies?
Are there any deadlines of which you are aware? (e.g. 90-day right to sue letter; fact finding conference, etc.)
How much were you paid?
Were you paid hourly or salary?
Were you injured at work?
How many hours did you typically work each week?
For weeks where you worked more than 40 hours, do you get paid time and a half for those extra overtime hours? (If you never worked 40 hours, please leave this blank.)
Have you ever been paid additional amounts beyond your regular salary or hourly wage (e.g. shift differentials, safety pay, commissions, hazard pay)?
Does your employer use any biometric data (scans of your finger, face, eyes, voice, or any other body part) for any purpose?
Are you aware of anything illegal occurring at your job (for example, overbilling the government, lying to government?)
* If we are not able to help you, is it OK if we share your information with another law firm who may be able to help?
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*Upload paystubs or other relevant documents.
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