Duchess

Duchess Director of Behavior Modification

About

She is the owner of her human and lets her know on a daily basis.

Likes to terrorize her subjects

Unemployment Intake Form

Please complete this form with all facts and details pertaining to your employment. This information will help us evaluate your situation more effectively.

First Name
Please enter your first name.
Last Name
Please enter your last name.
Phone
Please enter your phone number.

This isn't a valid phone number.
Email
Please enter your email address.

This isn't a valid email address.
Name of Employer
Please enter requested information.
Location You Worked
Please enter requested information.
Approximate Number of Employees
Please enter requested information.
Your position and general job duties/responsibilities
Please enter requested information.
Dates of Employment
Please enter requested information.
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.
Please enter requested information.
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?
What method were you paid?
Were you injured at work?
How many hours did you typically work each week?
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?
Has any person or entity related to your job ever required you to undergo a physical exam or asked about your family medical history (for example, questions about whether you have a history of heart disease in your family)?
Are you aware of anything illegal occurring at your job (for example, overbilling the government, lying to government?)
Does your employer have any contracts with the government or receive any government funding (e.g. Medicare, Medicaid, Department of Defense, etc.)?
If we are not able to help you, it is ok if we share your information with another law firm who may be able to help
*Upload paystubs or other relevant documents.
Please upload your resume.
- By checking this box, you agree to be contacted by text message (SMS) about your request. Message frequency varies. Msg & data rates may apply. Text STOP to cancel or text HELP for assistance. We do not share your phone number with any third parties for SMS purposes.Acceptable Use Policy