Employment Law Questionnaire

Please complete the following form in advance of your appointment. Thank you.

Name*

Email*

Address*


Phone*

Date of Birth*

Employer Name*

Employer Address*


Job Title*

Job Description*

Date of Hire*

What was rate of pay?*


0 of 100 max characters

Date of Adverse Employment Action*

Adverse Employment Action Taken*

Reason given by Employer for Adverse Action*

Reasons you feel were behind the Adverse Action*

Please explain/describe the circumstances for any of the above reasons that apply to your situation

Have you filed a complaint with any agency?*

If 'Yes', which Agency?

Have you received a ruling or decision?*

If 'Yes', please state the ruling or decision.

What losses have you suffered?*


0 of 700 max characters

(Lost wages- how much; lost bonuses/commissions;lost benefits; other)

Do you have an employment contract?*

Are you represented by a union?*

Have you applied for unemployment benefits?*

Have you obtained other employment?*

If 'Yes', where?

If you have obtained other employment, what is your new Job Title?

If you have obtained other employment, what is your new rate of pay?

How did you learn about ELLIOT MORGAN PARSONAGE, PLLC?