AJAX Employment intake form

AJAX Employment intake form

Employment Intake Questionnaire

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

How Did You Hear About Us?(Required)

Provide the name and address of your employer(Required)

Provide your dates of employment and rate of pay(Required)

What is the date(s) of the adverse employment action that you are contacting us about?(Required)

State how your employer discriminated against you or harassed you because of your protected status.(Required)

If you are claiming retaliation, what was the date of your complaint, the specific complaint you made, and what you claim to be the retaliation as a result.(Required)

Do you have a new job? If yes, when did you start and what is your rate of pay?(Required)

Have you ever been convicted of a crime? *If yes, please describe the conviction.(Required)

Have you ever been a party to a lawsuit?(Required)

Have you spoken with any other attorneys about this?(Required)

AJAX Employment intake form

Employment Intake Questionnaire

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

How Did You Hear About Us?(Required)

Provide the name and address of your employer(Required)

Provide your dates of employment and rate of pay(Required)

What is the date(s) of the adverse employment action that you are contacting us about?(Required)

State how your employer discriminated against you or harassed you because of your protected status.(Required)

If you are claiming retaliation, what was the date of your complaint, the specific complaint you made, and what you claim to be the retaliation as a result.(Required)

Do you have a new job? If yes, when did you start and what is your rate of pay?(Required)

Have you ever been convicted of a crime? *If yes, please describe the conviction.(Required)

Have you ever been a party to a lawsuit?(Required)

Have you spoken with any other attorneys about this?(Required)

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