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Employment Background

Are you a:

Former Employee

Current Employee

Employer's Name

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Were you terminated within the last 3 years in California:

Yes

Hire Date

Termination Date

Have you experienced:

Former Employee - Case Type - Harassment

Sexual Harassment

Former Employee - Case Type - Retaliation

Reporting Illegal Workplace Activity

Reporting Unsafe Work Practices

Refusing to Participate in Illegal Activity

Other

Former Employee - Case Type - LOA

Denied Medical/Family Leave for Yourself or Someone you care for

Employer capped the Number of Days I could be on a Leave of Absence

Only permitted to Return to Work on “Full Duty” or 100% healed, or without Restrictions

Denied reasonable accommodation and was terminated

What illegal activity did you refuse to participate in or what illegal activity did you complain about?

Did you communicate your refusal or complaint to HR or Your supervisor?

Yes

Who did you communicate your refusal to and or your complaint if not your supervisor or HR?

Approx what date(s) (Month and Year) did you refuse to participate and or complain about this activity?

Approx what date (Month and Year) were you fired?

If Others, Please Specify

What did your termination letter say, or what were you told was the reason for your termination?

Please tell me why you believe you were terminated/discriminated/retaliated against.

* required

Your Information

First Name

Last Name

Phone

Email Address

Employment Background

Are you a:

Former Employee

Current Employee

Employer's Name

Were you terminated within the last 3 years in California:

Yes

Hire Date

Termination Date

Have you experienced:

Former Employee - Case Type - Harassment

Sexual Harassment

Former Employee - Case Type - Retaliation

Reporting Illegal Workplace Activity

Reporting Unsafe Work Practices

Refusing to Participate in Illegal Activity

Other

Former Employee - Case Type - LOA

Denied Medical/Family Leave for Yourself or Someone you care for

Employer capped the Number of Days I could be on a Leave of Absence

Only permitted to Return to Work on “Full Duty” or 100% healed, or without Restrictions

Denied reasonable accommodation and was terminated

What illegal activity did you refuse to participate in or what illegal activity did you complain about?

Did you communicate your refusal or complaint to HR or Your supervisor?

Yes

Who did you communicate your refusal to and or your complaint if not your supervisor or HR?

Approx what date(s) (Month and Year) did you refuse to participate and or complain about this activity?

Approx what date (Month and Year) were you fired?

If Others, Please Specify

What did your termination letter say, or what were you told was the reason for your termination?

Please tell me why you believe you were terminated/discriminated/retaliated against.

* required

Your Information

First Name

Last Name

Phone

Email Address

Employment Background

Are you a:

Former Employee

Current Employee

Employer's Name

Were you terminated within the last 3 years in California:

Yes

Hire Date

Termination Date

Have you experienced:

Former Employee - Case Type - Harassment

Sexual Harassment

Former Employee - Case Type - Retaliation

Reporting Illegal Workplace Activity

Reporting Unsafe Work Practices

Refusing to Participate in Illegal Activity

Other

Former Employee - Case Type - LOA

Denied Medical/Family Leave for Yourself or Someone you care for

Employer capped the Number of Days I could be on a Leave of Absence

Only permitted to Return to Work on “Full Duty” or 100% healed, or without Restrictions

Denied reasonable accommodation and was terminated

What illegal activity did you refuse to participate in or what illegal activity did you complain about?

Did you communicate your refusal or complaint to HR or Your supervisor?

Yes

Who did you communicate your refusal to and or your complaint if not your supervisor or HR?

Approx what date(s) (Month and Year) did you refuse to participate and or complain about this activity?

Approx what date (Month and Year) were you fired?

If Others, Please Specify

What did your termination letter say, or what were you told was the reason for your termination?

Please tell me why you believe you were terminated/discriminated/retaliated against.

Call Us! (562) 328 2004

WorkRight Law

WorkRight Law

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Call Us! (562) 328 2004

WorkRight Law

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Employment Background