Pre Interview Name *CityStateEmail *Phone Number *Name of EmployerIn which city do or did you workNumber of local employeesCurrent or most recent positionHow long employed?Your salary or hourly wageIf you quit or were terminated, date of quit or terminationIs your leaving your employment what is motivating you to contact an attorneyIf you are not now employed, under what circumstances did you leaveIf 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 wasIs there a reason other than or in addition to your termination, what is the situation that is leading you to contact an attorneyIf your complaint is about harassment, describe the nature of the harassmentWhat is the harasser's position (co-worker, supervisor)What do you think is motivating the harassment (sex, race, religion, etc)Did you complain about the harassment?YesNoIf yes, to whom did you complain (supervisor, HR, EEO, DFEH)If your complaint is about disability/reasonable accommodation, describe your disability, the accommodation needed, and any communications with your employer on the subjectAre you a union member?YesNoHave you made a complaint to any government agency (DFEH, EEOC, DLSE, etc.) and, if so, what is the status of that complaintWhat do you want the lawyer to do for you?Are there any other comments you think are important for the lawyer to knowHow did you learn about this office?NameSubmit