Employer Questionnaire

Disclaimer:  Completing this form does not create any attorney-client relationship.  Thus, no information provided by you shall be considered confidential or protected by an attorney-client confidentiality until our office is officially and adequately retained as your attorney and allowed a full opportunity to review for any conflict of interest.

 

General Info

Your First Name:
*

Your Last Name:
*

Your Middle Name (Optional):

Name of Business:

DBA:

Business Address:

Business Telephone:

Business Fax:

E-mail:
*

Nature of Business/Industry:

What is your title/position at the Company?

Check all labor issues that you believe may apply to the Company's situation:

Overtime Violation
No W2/Checks
Discrimination
Disability Discrimination
Minimum Wage Violation
No Meal/Rest Breaks
Harassment
Whistle Blower
Unpaid Commission
Unpaid Expenses/Mileage
Wrongful Termination
Retaliation

If other, please describe:

Are there any other lawsuits against your company?

Yes
No

If so, what type of lawsuit?

Which Court?

Civil Court
US Dept. of Labor
CA Labor Commissioner
Worker's Compensation
Other

If other, please specify:

Is there a class action?

Yes
No

What is the total amount demanded by the claim/complaint?
$

Which date was your Company served with the Complaint?

Date of Claim or Incident?


Company Info

Are you still working at this Company?

Yes
No

What is the total number of employees at this Company?

When was this Company established?

Is this Company still active?

Yes
No

If not, when was this Company dissolved?

Does this Company have a Human Resources Department in place?

Yes
No

Is this company currently insolvent?

Yes
No

Please list all the current Officers/Directors/Partners of this Business:

 

 

Pay and Hours

How does your company keep track of Employee Time? 

None
Timesheets
Time Cards
Log-in Computer
Other

If Other, please specify:

Please check all the ways your company pays:

Independent Contractors
Salary
W2
Bonuses
Commissions
Tips
Projects
Other

If other, please specify:

 

 

Attorney Information

Have you spoken to another attorney?

Yes
No

Who was the attorney?

Have you retained an attorney?

Yes
No

If you have not retained an attorney, why have you not retained an attorney?

 

I acknowledge that the foregoing information I am providing is solely for the purpose of having my case reviewed. I understand that the submission of this information does not form an attorney-client relationship. I certify that the information I have provided in this questionnaire is true to the best of my knowledge and belief.*

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