EMPLOYMENT LAW - EMPLOYEE

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Your Name* This field is required.

Prefix

First Name

Middle Name

Last Name

Suffix

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Cybersecurity, Technology, Security and Communications Consent* This field is required.n order to provide our clients with efficient and convenient legal services, our law office will communicate and transmit documents using e-mail, social media, cell phone, text messages, internet and web and fax. Because cybersecurity and technology as a whole continues to evolve, there may be risks communicating in these manners, including risks related to confidentiality and security and those associated with being hacked. By entering the information on this form, you are consenting to such e-mail, social media, cell phone, internet, zoom, web and fax communications. You are also acknowledging the risks and accepting them. In addition, our law office uses Drop-box and other cloud based technologies and services with servers located in facilities outside of our office. Most of our electronic data, emails, and documents are stored in this manner. By entering the information on this form, you understand and consent to having communications and documents pertinent to your Matter stored and handled in this cloud based manner. Because technology continues to evolve, there are risks, as already discussed above. By filling out your name and putting your initials below, you knowingly, intelligently consent to everything in this paragraph.

Prefix

First Name

Middle Name

Last Name

Suffix

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How did you find our law office?* This field is required.Please give name and contact info of the person / attorney or website and contact info.

Name of referring party or website

Contact info.

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Your Contact Phone Number* This field is required.

Area Code

Phone Number

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Email* This field is required.

example@example.com

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Your home address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Name of your employer* This field is required.

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Employer's address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Date of hire

Date

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Job Title* This field is required.

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How much do/did you earn per hour/year?* This field is required.Please specify "per hour" or "per year" based on which figure you provide

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How long have you been working there?* This field is required.

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Date of leave or terminationIf you are still employed here, you may leave this blank

Date

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How large is your employer?* This field is required.

Fewer than 10 employees

50 or less employees

50 or more but under 100

Over 100

Fortune 500

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Is there a union?* This field is required.

Yes, I have gone through the grievance process

Yes, but I'm not union

Yes, and I have not gone through the grivence process

No

I don't know

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Describe the facts and relevant timeline of events. Approximate dates/months are acceptable if you can't remember the specific dates. Please also give the name, title, and contact info of the decision makers, executives, managers, HR, and important parties involved.* This field is required.If you have a timeline, putting things in chronological order with dates help organize the events. Thanks.

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When was the last time you were involved in a car accident?

Within the last 6 months

Within the last 12 months

Within the last 5 years

Never

It's been more than 5 years

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When was the last time you filed a lawsuit?* This field is required.Mark all that apply

Small claims in the last 12 months

Worker's comp in the last 12 months

Wage and hour or discrimination against another employer in the last 2 years

A different law suit in the last 2 years

Never filed a lawsuit

Never been sued

Personal injury claim in the last 2 years

Filed an EEOC or DFEH claim in the past 12 months

Worker's Compensation within the last 2 years

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Upload all photos and documents you have associated with this case.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Have you talked to another lawyer about this?* This field is required.

Yes, in the last 3 months

Yes, in the last 12 months

No

Just some phone calls

Yes, I have a lawyer now

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Are you currently still employed?

Yes, same employer

Yes, but different employer

No, unemployed

I don't know for sure

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What is your preferred method of communication?Mark all that apply

Email

Phone Call

Text Message or IM

Other

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How often do you check email?Mark all that apply

Many times every day

At least once a day

Every once in a while

Not often

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What is your preferred spoken and written language?Mark all that apply

English fluent

Korean fluent

Spanish fluent

English is a second language

Other preferred

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Are you interested in a zoom meeting/consultation?* This field is required.By clicking "Yes", you consent to and accept the risks involved with Zoom meetings, including those related to privacy. You must be in a private and quiet area without anybody else in the room during the meeting.

Yes

No

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Within the next 7 days, pick 3 dates and times when you can be available for a 20 minute phone consultation.* This field is required.

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We are sometimes a busy office and each client is unique and equally important to us. Although we welcome your calls and emails anytime, it is usually best to schedule a time specifically dedicated to your needs so that we can both be focused on the issues most important to you. Also, if for some reason we are not able to return your call or email within 2 days, please follow up. Thank you for taking the time to fill out this form. It goes a long way in helping to get things started. * This field is required.

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Please let us know if you have any plans to move, change jobs, or go on vacation in the next 12 months? Please give us details. It is important that we be able to contact you and that we are aware of any major changes that might impact your case.

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