Are you a U.S. Citizen?
I am employed by:
Agency or division by which I am employed:
Are you still employed with this employer?
Hiring Circumstances (including who hired you and how you learned about this job)
Were you issued any employment evaluations?
Did you receive any other awards or evaluation of your employment?
Were you ever disciplined in the past prior to the event about which you are currently complaining?
Are there any witnesses or other co-workers who can testify your claims?
Was your position covered by Union contract (even if you are not a union member)?
Are you a member of a union?
Have you initiated a Union grievance regarding the matter you are describing in this questionnaire?
Have you ever been arrested for a crime?
What is the nature of your case?
Have you obtained vested status with the employer? (Completed Probation)
Are you a permanent employee (as opposed to a temporary employee)?
Does this involve a disciplinary matter?
Are you alleging a failure to hire or failure to promote, or are claiming a denial of hiring or promotion based on veteran's preference?
Are you claiming a violation of veteran's preference?
Do you believe that the action of which you complain is related to any discrimination based on:
Why do you believe the action involves discrimination on such basis or bases?
How did you learn of our firm?
Please provide any additional information about yourself or the case which would help the attorneys understand you potential case or explain your answers to the above questions.
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 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 obligated to schedule a meeting 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 THIS FORM!
I agree with the terms of this form