Discrimination and Harassment Intake Form

*Are you still employed with the company?

yes no

*Employment Type

*Type of Violation(s):

Discrimination based on: Race, Gender, Age, Religion, Disability, Sexual Orientation, Pregnancy, National Origin Harassment: Sexual, Verbal, Physical, Retaliation Other

*Any Prior Complaints to Employer?

Yes No

*Have you previously participated in any class action lawsuits with this employer?

Yes No

*Are you aware of other employees with similar claims?

Yes No Unsure

*Have you filed any claims or complaints with government agencies?

Yes No

*Are there any ongoing or prior disputes with the employer?

Yes No Unsure

*WARNING: By submitting information through this intake form or by email or other communication to this web site, you agree that the communication does NOT create a lawyer-client relationship between you and the law firm and its lawyers and that any information submitted is not privileged. You further acknowledge that unless the law firm subsequently enters into a lawyer-client relationship with you, any information you provide will not be treated as privileged, and any such information will not be preserved or maintained by this law firm, nor will it be subject to this law firm’s policy on client file retention. I have read and agree to the above warning statement (Please indicate that you have by selecting “yes”).

Yes No

Discrimination and Harassment Intake Form

Discrimination and Harassment Intake Form:

Definitely recommend to family and friends so why not to my google family.

-Steven Winter

Nice people and they found things apart from wrongful termination

-Carlos Niktkolwiek

Like all cases it took time but I am very happy with how everything turned out

-Eric Chabez

California

Washington

California

Washington

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