Case Analysis Intake Form

Case Analysis Intake Form

All information and communications submitted through this intake form are strictly confidential and protected by the attorney–client privilege. By providing these details, you agree that no waiver of privilege occurs, and that all disclosures made in connection with this potential representation are intended to remain privileged and confidential.
Contact Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Date of Birth
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment Information
Employer/Company Name
Employment Start Date
Position Title (Most Recent)
What was the name and position title of your supervisor?
Salary (or Hourly Wage)
Are you still employed?
When did your employment end?
Did you have any direct reports?
Separation Agreement
Were you offered a severance or separation agreement?
Do you need legal assistance in reviewing your separation or severance agreement?
Were you terminated or laid-off in a reduction-in-force or reorganization?
If you were terminated/laid-off in a reduction-in-force, how many others were terminated/laid-off at the same time?
Please describe how you found out that your employment was ending (including who informed you, what he/she said, and other details)?
If your position was eliminated, or you were laid off in a reduction-in-force/reorganization, did your job duties go away, were they reassigned to someone else, or was someone hired to take them over? (Please describe)
Employment Performance
Did you receive performance reviews?
Were your performance reviews generally positive, negative, or neutral?
Were you ever given a written warning, placed on a performance improvement plan, or subject to performance-based discipline?
Discrimination/Retaliation
Do you believe that any of the following reasons contributed to your termination or discharge?
Did supervisor, manager, team leader, or human resource personnel say anything or do anything that suggests the reason(s) identified above? If so, summarize the details of any relevant comments (who, what, when, etc.):
Please share any other details or information that you would like our attorneys to review:
By submitting this information, you acknowledge and agree that no attorney–client relationship is formed through this intake process. Tyler W. Brennan Law, LLC is not your attorney unless and until a formal retainer agreement is signed by both you and the firm.
Please verify that you are human
Should be Empty:

Case Analysis Intake Form

Contact Information

Employment Information

Separation Agreement

Employment Performance

Discrimination/Retaliation