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The best way of getting in touch with us is to take a few minutes and fill out the form below. The form allows us to route your issue to the best person who can serve you. You need to fill out the entire form in order to submit it and be considered. We look forward to serving you.

Please complete all required fields:

Contact Information

(All fields with * are required)

First Name * First name is required

Last Name * Last name is required

Email * Please enter a valid email address

Phone Number * Please enter a valid phone number (at least 10 digits)

City and State where you worked * City and state are required

Were you referred to our office? *

Yes No

Please select an option

Employer Information

Employer Name * Employer name is required

Employer Address

Approximate Number of Employees * Number of employees is required

Your Position/Role * Your position/role is required

Date of Hire *

Please enter your date of hire

Salary or Hourly Rate * Salary or hourly rate is required

Commissions/Tips/Bonuses (if any)

Employment Status

Were you terminated? *

Yes No

Please select an option

Did you receive a severance agreement? *

Yes No

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Discrimination & Protected Rights

Do you believe your employer fired you, suspended you, cut your hours, or treated you differently because of a protected characteristic (age, gender, sexual orientation, race, disability, etc.)? *

Yes No

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Are there other employees that you think feel the same way? *

Yes No

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Are there other employees that you think may testify in your favor? *

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Complaints & Retaliation

Did you make any complaints prior to your termination? *

Yes No

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Sexual Harassment

Did you experience sexual harassment prior to your termination? *

Yes No

Please select an option

Compensation Issues

Do you believe you were not paid appropriately? *

Yes No

Please select an option

Additional Information

Please provide any additional information about your case

Are you ready to get started?

Get In Touch With Us

Contact Information

Employer Information

Employment Status

Discrimination & Protected Rights

Complaints & Retaliation

Sexual Harassment

Compensation Issues

Additional Information

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