Jake and Daisy

Jake and Daisy

About

Jake: master frisbee catcher

Daisy: lord of eating and sleeping

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
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Last Name
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Phone
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Email
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Name of Employer
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Location You Worked
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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?
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.
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