Employment Law - Employee Intake Form

Name

First Last

Address:

Street Address Address Line 2 City State ZIP Code

E-mail address:

Home Phone:

Business Phone:

Cellular or Pager:

How would you like to be contacted?

Please provide the name and address of the employer involved:

I am a

Can you be contacted at work?

Describe your situation, including any relevant dates:

Have you made a complaint about your situation to any governmental agency?

If yes, provide the name of the agency, the date you made your complaint, and the final result, if any, of your complaint:

Are any other people involved?

If yes, provide names, addresses (if known), and their relationship to you, if any:

Do you have any documents that could help explain your situation?

If yes, list those documents and their dates:

Are there other documents that you do not have access to that could be of assistance?

If yes, list those documents and their dates and locations (if known):

Describe how this situation has impacted you:

Describe what you would like to happen to resolve your issue (your preferred outcome):

Have other attorneys worked on this matter?

If yes, provide names, addresses, and a brief description of their involvement:

Special concerns:

Where did you hear about this website?

Employment Law – Employee Intake Form