Employment Law Intake Form
Contact Number
Contact Number
Contact Number
Contact Number
"Before we get started, please keep in mind we do NOT give any type of legal advice. We only bring lawsuits."
**Wait for a response. **
"Thank you for your time. Unfortunately, there's not much we can do at this time but if you do change your mind, please do not hesitate to contact us."
IF THE ANSWER IS NO, READ THIS.
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Name of Person Doing the Intake
Date
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Month
-
Day
Year
Date
Client Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Preferred Language:
Gender
Male
Female
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Employment Details
Occupation
For how long?
Race/Ethnicity you identify yourself with:
Date of Hire:
*
Employer's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Termination:
Last Day of Work?:
*
Are you part of a Union?:
*
Were you hired directly or did your company use a staffing agency?
*
Number of Employees (approx.):
*
Which location did you work at (address, city):
*
Other Business Locations?
*
Did you work in other addresses, locations ?
*
Position (job title):
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Duties:
*
Hourly or Salary Pay and How Much?
*
When were you paid?
*
How did you receive your work schedule
*
How many hours did you work per day?
*
If applicable, Did you work more than 10 hours a day? if yes, how often?
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At what time did you start work?
*
At what time did you end work?
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On what days did you work?
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Is this a set schedule?
*
Do you think you were paid OT?
*
How were your hours recorded?
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Do you have copies of Timesheets?
*
Copies of Pay Stubs? (Yes/No)*
Copies of Employee Handbook?
*
Did you get a 30-minute lunch break on days that you worked above 6 hours?
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If so, at what time did you take lunch?
Was lunch ever interrupted?
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When you worked more than 10 hours in a shift were you given a second 30-minute meal break?
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If not, how often did you work over 10 hours in a shift without a second lunch break per week?
Were your lunch breaks recorded (i.e., clock in/out for lunch?)
*
Did you get a rest break aside from lunch?
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If so, at what time(s) did you take your rest break(s), and how many were taken?
How many minutes was each rest break?
Did you have to clock out for rest breaks?
Were you ever required to work off-the-clock? If yes why?
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Did you have to wear uniforms for work (if yes, what does the uniform consist of?)
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If you have a uniform for work, would it get dirty at work? How so?
Who would pay for the laundry of your uniform?
Did you have to use tools for work and, if so, who would pay for them?
*
Did you have to use your personal vehicle for work and, if so, who would pay for your gas/mileage?
*
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Trucking Questions
(If Applicable)
Did you have to drive across state lines or just in CA?
Where are you based out of?
What was the weight of the truck you were driving?
What were you transporting in your truck? Hazardous waste?
How were you paid? By mileage? How much per unit? Some other way?
How were you paid? Personal check or company check?
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Did you receive your final check?
*
Employee Reason for Termination (Employers reason):
*
What is your goal in contacting us?
*
Employee Reason for Termination (Employees reason):
*
COMMENTS THAT MAY BE OF VALUE TO YOUR CASE
Should be Empty: