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Helping People Who Have Been Wronged In The Workplace
New Client Information

NOTE: An asterisk (*) indicates REQUIRED information. The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

*Name:

*Email address:

*Phone Number:

Cellular Number:

*Address:

*City:

*State:

*Zip:

*What is the name and address of the employer that you want to complain about?:

*Date of Hire:

Date of termination:

Salary or wage:

*Why were you terminated? Describe your situation, include relevant dates or a timeline:

Check the box for each governmental agency that you complained to about your situation?
EEOC
Dept of Fair Employment and Housing
Labor Commissioner
Employment Development Dept.
Other

If other, please describe:

Have other attorneys worked on this matter?
Yes No

If yes, provide names, addresses, and a brief description of their involvement:

Describe what you would like to happen to resolve your issue (your preferred outcome):

Special concerns or anything else that you want to tell us:

How Can We Help You?

Please fill out the form below or call us at 559-432-0986 or 916-551-1556.

NOTE: Labels in bold are required.

Contact Information
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