First name
Last name
Email
*
Phone Number
*
Please enter a valid phone number.
Phone number in Whatsapp, if different
Name of the Employer trying to charge you fees if you quit
*
State where you worked
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Around when did you start working?
*
Approximately, what date did you start working? (It does not need to be exact)
Approximate end working date
*
Approximately, what date did you stop working? (It does not need to be exact)
Provide a brief summary of the working conditions and/or your reasons for quitting
*
Did your employer threatened immigration consequences for attempts to leave?
*
Provide a brief summary of the costs the employer says you "owe"
*
Amount of the debt
*
Length of required employment period
Has your employer made any attempts to collect?
*
Yes
No
No, because I didn't leave my position early
If Yes, please explain
Additional comments or questions
If needed, do we have your authorization to share your information with other Attorneys in our network? The shared information will remain confidential within our network of Attorneys.
*
Yes
No
Submit
Should be Empty: