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Employment Law - Employee Intake Form

Employment Law - Employee Intake Form

*Name:

*Address:

*City:

*State:

*Zip:

*E-mail address:

*Home Phone:

Business Phone:

Cellular or Pager:

Facsimile:

Please provide the name and address of the employer involved:

Are you a current
employee  former employee  job applicant  or prospective employee  of this employer?

Are you presently employed?
Yes  No 

If yes, please provide your job title and employer's name and address.

Can you be contacted at work?
Yes  No 

Describe your situation, including any relevant dates:

Are you a union member?
Yes  No 

If yes, provide the name, address, and local number:

Have you made a complaint about your situation to any governmental agency?
Yes  No 

If yes, provide the name of the agency, the date you made your complaint, and the final result, if any, of your complaint:

Are any other people involved?
Yes  No 

If yes, provide names, addresses (if known), and their relationship to you, if any:

Do you have any documents that could help explain your situation?
Yes  No 

If yes, list those documents and their dates:

Are there other documents that you do not have access to that could be of assistance?
Yes  No 

If yes, list those documents and their dates and locations (if known):

Describe how this situation has impacted you:

Describe what you would like to happen to resolve your issue (your preferred outcome):

Have other attorneys worked on this matter?
Yes  No 

If yes, provide names, addresses, and a brief description of their involvement:

Special concerns:

Where did you hear about this website?

 

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Contact Information
  1. disclaimer.

Collins & Bellenghi
1300 Quail St.
Suite 207
Newport Beach, CA 92660
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Phone: (949) 851-9311

We take cases from Northern California, through Silicon Valley, down to the East Bay area and Southern California, including the cities of San Francisco, Oakland, Concord, Fremont, Stockton, Los Angeles, Newport Beach, Gilroy, San Jose, Fairfield, Hayward, San Diego, Sacramento, Redwood City, Richmond, Santa Barbara, Long Beach, San Bernardino, Riverside, Palm Springs, Lancaster, and Palmdale, in San Mateo County, Santa Clara County, Alameda County, Sacramento County, Orange County, Los Angeles County, San Diego County Riverside County, and Ventura County.