Please use the form below to request a consultation or additional information. Items marked with an asterisk (*) are required.

* Your Name:

* Phone (Day/Evening and/or Work, Home, or Cell):

* Your Email Address:

Is this this email address provided by your employer?
Yes
No

* Name of Employer:

Number of Employees:

Your Position:

Briefly describe your typical duties:

Were/Are you paid a salary or an hourly rate?
Salary
Hourly

Salary or Hourly Rate:

Length of Employment:

If you quit or were terminated, date of resignation or termination:

Did/Do you have an Employment Contract?
Yes
No

Did you sign an arbitration agreement with your employer?
Yes
No
I Don't Know

If your complaint is about unpaid wages, what kind of wages do you believe are due?:

If you are not now employed, under what circumstances did you leave?

If you were terminated or laid off, what was the reason your employer gave you (even if you do not believe it)?

If you do not believe your employer's reason, what do you think the real reason was?

If there is a reason other than or in addition to your termination, what is the situation that is leading you to contact an attorney?

If your complaint is about sexual harassment, describe the nature of the harassment:

What is the harasser's position? (i.e., supervisor, co-worker)

What do you think is causing/caused the sexual harassment?

Did you complain about the sexual harassment?
Yes
No

If yes, to whom did you complain? (Identify by position, i.e., my supervisor)

If your complaint is about discrimination, what type of discrimination? (check all that apply):

Gender
Race
National Origin
Ancestry
Mental Disability
Physical Disability

Age
Sexual Orientation
Permanent Residency
Marital Status
Medical Leave
Other:

If age discrimination, how old are you?

If your complaint is about sexual harassment or discrimination, have you filed a claim with the DFEH and/or EEOC?
Yes
No

If your complaint is about unpaid wages, what kind of wages do you believe are due?

Did/Does your employer keep track of your hours worked? (i.e., time clock, time cards)
Yes
No

If salaried, do you believe you are/were properly classified as an exempt employee? If not, why?

If salaried, did/do you spend the majority of your time with managerial and administrative duties?
Yes
No

If salaried, did/do you earn at least $2,340.00 per month?
Yes
No

Were/Are you classified as an independent contractor?
Yes
No

If yes, do you believe you should be/should have been classified as an employee? If so, why?

Did/Do you normally work over 40 hours per week?

If yes, how many hours per week did/do you work on average?

Did/Do you get paid time and one-half for your overtime?
Yes
No

Were/Are you given paid 10 minute rest breaks for every 4 hours worked?
Yes
No

Were/Are you given unpaid meal breaks of at least 30 minutes for every 5 hours worked?
Yes
No

Are there other current or former employees that are in the same situation?
Yes
No

Any additional comments?