Consultation Form "*" indicates required fields Your first and last name* Preferred Pronouns* Your email address* Phone Number*Street Address* City* State* Zip* How did you hear about us?*EMPLOYER INFORMATIONWho do you work for?* Private Employer Government Agency or department What is the name of your employer?* What department do you work in? What is/was your position and briefly, what are/were your job duties? What is/was your last rate of pay? Approximately how many employees work for your employer? What office or location do you work from or are you assigned to? How long have you worked/did you work for your employer? Did you supervise any employees? Yes No Who was/is your supervisor? Are there other supervisors or employees who have been involved in your situation at work? If so, what are their names? Do you know of any deadlines that are coming up, or meetings or hearings that have been scheduled? If so, what dates/deadlines? SPECIFIC INFORMATION ABOUT YOUR SITUATIONWhy do you need to see a lawyer?* Terminated Resigned Resigned under threat of termination Still employed Has your employer taken other negative actions against you like discipline, suspension, demotion? Please explain what and when.Do you need advice about ongoing problems at work? Yes No Do you need us to review any documents or agreements (such as severance agreements, non-compete agreements, or employment agreements)? Yes No Do you need to be represented because of an upcoming hearing or meeting? Yes No Other issue(s)Do you feel you have been discriminated or harassed because of: Sex or gender Sexual orientation Gender identity Race or color National origin Religion Disability Age Medical leave Military leave Immigration status Other Do you believe your employer has retaliated against you because you did one or more of the following? Reported discrimination/harassment Reported fraud Reported corruption Reported illegal activity Reported waste Spoke out on an important matter Participated in an investigation Other Do you believe you have been wrongly terminated? If so, why?Are there other issues or concerns that you have about any of the following? (Check all those that apply.) Not being paid overtime or proper wages Contract issues (such as non-compete agreements, severance agreements, or employment contracts) Union activities Unemployment compensation Disability insurance Retirement Severance None of these Provide a brief explanation of why you marked the boxes above and/or a description of your issues:Provide critical documents (doc, docx, pdf)Max. file size: 50 MB.DAMAGESHave you lost any wages as a result of the actions taken against you? If so, how much? What other damages or injuries have you suffered? Have you had to seek medical help (including going to see a counselor) as a result of the actions taken against you? Explain briefly. As noted above, we charge for our initial hour consultation. The price of that consultation varies depending on the experience of the lawyer you meet with and is typically between $175-300. Are you willing and able to pay?* Yes No