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SD&A EMPLOYMENT LAW REFERRAL INFORMATION

Employment Law Referral from attorney:
Phone:
Name of Potential Client:
Contact phone with area code and e mail:
Name of Employer:
Estimated total number of employees:
How many at your location if multiple locations?
City in which you worked:
When did you start employment?
Legal to work in US?
What was/is your job title and rate of pay?
If employment ended, final date:
Have you started a new job since leaving?
If yes, are you earning at least as much as before you left old job?
Date you started new employment (if applicable)
What do you believe employer did that was illegal? (eg, industrially injured worker or other discrimination, whistle blower retaliation, etc.)
Are there witness (es) to your claim:
What reason did employer tell you they were taking the adverse action against you?
Have you complained to any governmental agency such as Labor Board or EEOC/DFEH?
If yes, what date did you first complain?
If yes, has the agency investigated your charges?
Are you a union member?
If yes, have you filed a grievance?
SUBMISSION OF THIS FORM DOES NOT CONSTITUTE RETENTION OF SD&A AS YOUR LAW FIRM OF RECORD.