Intake Questionnaire for Employment Cases

Name

Phone

Email

Date

Name of Employer

Employer company type

Last Position Held

Terminated by employer?

Date Terminated

If not terminated, have you resigned? (You shouldn’t resign unless a lawyer tells you to!)

Date Resigned

If you resigned, do you have written proof that your only choice was “resign or be fired?”

If so, please attach it.

Click or drag a file to this area to upload.

What reason did the employer give for your termination?

What do YOU think is the REAL REASON this happened to you?

What were you making annually at the time of termination / resignation?

Have you filed an EEOC or TWC Charge?

If you filed an EEOC or TWC Charge, please attach it.

Click or drag a file to this area to upload.

If so, when?

Did this case involve an employee who was sexually harassed or sexually assaulted?

Was that employee a minor?

Name

Address

Other information

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