Non-Compete & Employment Agreements - Questionnaire

Name:

Address (include city, state and zip):

Telephone:

- Home

- Work

- Cell

Email address:

Confirm email:

Date of birth (MM/DD/YYYY):

Place of birth:

Gender:

--Select-- Male Female

Employer about whom you are contacting us:

Address of employer:

Rate of Pay:

per --Select-- Hour Week Month Year

Hire Date:

Current Position (if still employed)?

Last position held

Are you still employed with this employer?

--Select-- Yes No

If no, why did you leave?

Hiring Circumstances (including who hired you and how you learned about this job)

Were you issued any employment evaluations?

--Select-- Yes No

If yes, how well were you evaluated?

Did you receive any other awards or other evaluations of your employment?

--Select-- Yes No

Please describe the award or evaluation with the date you received it.

Were you ever disciplined by your employer?

--Select-- Yes No

Please describe the discipline with the date you received it.

Did you sign a written non-compete agreement?

--Select-- Yes No

Is your non-compete agreement a part of a general employment contract between you and your employer?

--Select-- Yes No

If so, are there any provisions of the contract which you believe the employer has breached or violated?

--Select-- Yes No

If so, what provisions of the contract do you believe the employer has breached?

Do you feel that the employer has violated any state or federal laws regarding harassment or discrimination based on protected characteristics (race, sex, disability, national origin, marital status, pregnancy, veterans status, age, etc.)?

--Select-- Yes No

Please explain.

Do you feel that the employer has violated any other laws relating to your employment (i.e., whistle blower retaliation or other retaliation, failure to pay overtime, etc.)?

--Select-- Yes No

Please explain.

Have you executed any other agreements with the employer after you entered into the non-compete agreement?

--Select-- Yes No

If so, If so, did the later agreement specifically reference the earlier non-compete agreement?

--Select-- Yes No

Did the later agreement state that it invalidated or rendered void all previous agreements?

--Select-- Yes No

Did the employer otherwise take any action or fail to take any action during the period of your employment which you feel prevented you from continuing your work with that employer (i.e., maintain policies which would have required you to violate standards for your profession or which would have required you to behave in a dishonest or disreputable fashion)?

--Select-- Yes No

If so, please describe.

In what type of industry are you employed?

Is this a competitive industry?

--Select-- Yes No

Do customers deal with the various companies in your industry based solely on the price offered by the companies?

--Select-- Yes No

In leaving the company, will you or have you been able to bring any customers with you to your new employer?

--Select-- Yes No

If so, please describe.

Does the employer with whom you have entered into a non-compete agreement have any trade secrets, customer lists or distinctive methods of operation which provide it any specific advantage in your industry?

--Select-- Yes No

If so, please describe.

How will (or how has) your leaving your employer affect that employer's overall business standing, profitability or competitiveness?

What is the term (length and time) which the non-compete agreement prohibits you from working in a competing or similar business?

What is the geographic area in which you are prohibited from working under the non-compete agreement?

Does the employer have offices or locations elsewhere in the State of Florida?

--Select-- Yes No

If yes, in what cities are the offices or branches located?

Based on the geographic area listed in the non-compete agreement will you be prevented from working in the State of Florida?

--Select-- Yes No

Are there any specific reasons why you believe the non-compete agreement would not be enforceable?

Were you paid overtime payment of time and a half your regular wage for hours worked in excess of 40 a week?

--Select-- Yes No

If no, explain why you were not paid overtime.

How did you learn of our firm?

--Select-- Attorney Yellow Pages Newspaper Article Web Search Other

If an attorney referred you, what is the name of the attorney or firm?

If another person referred you, what is that person's name?

Additional Information

Please provide any additional information about yourself or the case which would help the attorneys understand your potential case or explain your answers to the above questions.

Scheduling

We will contact you by phone or email unless you request some alternate means of communication.

PLEASE READ THE FOLLOWING STATEMENTS AND INDICATE YOUR ACCEPTANCE OF THESE TERMS PRIOR TO SUBMITTING THIS FORM.

I have prepared the answers to these questions and to the best of my ability.

I understand that the submission of this form does not create any obligation for me or for any attorney at Delegal Law Offices.

I further understand that submission of this form does not create an attorney-client relationship and that the lawyer is not obliged to schedule a consultation with me.

I understand and agree that Delegal Law Offices, P.A., will have no duty to keep confidential the information that I am transmitting to the law firm through this questionnaire.

YOU MUST AGREE OR YOU CANNOT SUBMIT THE FORM!

I do not agree I agree