Cart Your cart is currently empty. Return to shop 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? YES NO What was/is your job title and rate of pay? If employment ended, final date: Have you started a new job since leaving? YES NO If yes, are you earning at least as much as before you left old job? YES NO 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: YES NO 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? YES NO If yes, what date did you first complain? If yes, has the agency investigated your charges? YES NO Are you a union member? YES NO If yes, have you filed a grievance? YES NO SUBMISSION OF THIS FORM DOES NOT CONSTITUTE RETENTION OF SD&A AS YOUR LAW FIRM OF RECORD.
