Your position and general job duties/responsibilities
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?
Yes
No
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?
Hourly
Salary
Were you injured at work?
Yes
No
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)?
Yes
No
Does your employer use any biometric data (scans of your finger, face, eyes, voice, or any other body part) for any purpose?
Yes
No
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)?
Yes
No
Are you aware of anything illegal occurring at your job (for example, overbilling the government, lying to government?)
Yes
No
Does your employer have any contracts with the government or receive any government funding (e.g. Medicare, Medicaid, Department of Defense, etc.)?
Yes
No
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
Yes
No
