Durham North Carolina Attorneys

Durham North Carolina Lawyers: (919)683-2135  

Durham Personal Injury & Malpractice Lawyers - NC Attorneys

Durham North Carolina Attorneys handling:  Personal Injury  |  Professional Malpractice  |  Wills & Estate Litigation
Unfair Trade Practices  |  Employment Discrimination  |  Civil Rights  |  Land Condemnation
 


  Glenn, Mills, Fisher &    
  Mahoney, P.A.
  709 Southbank Building
  400 West Main Street
  Durham, NC 27701
  Directions

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Case Inquiry

EMPLOYMENT CASE INFORMATION

Please fill out this form as completely as possible. In order to evaluate your case, we must have complete responses to the questions. All information your provide is confidential. After we have received your completed form, an attorney will review your case and determine whether or not this firm can represent you. We will contact you within one week of receiving your completed form to inform you of our decision or to request additional information. Please return your completed form immediately, as there may be important deadlines in your case. THIS FIRM DOES NOT REPRESENT YOU AT THIS TIME. If you need immediate legal assistance, you should contact another attorney.

Name:  
E-mail:  
Address:  
City:  
State:  
Zip Code:  
Telephone (home):  
Telephone (work):  
     
Employer:  
Employer's Address:  
Your Job Title:  
Your Supervisor:  
Annual Salary/Hourly Wage:  
Number of Employees:  
     
Have You Been?:  
When Did This Happen?:  
Briefly describe what happened:  
What reason, if any, did your employer give for taking this action?:  
What do you think was the true reason your employer took this action?:

  
Do you believe you have been discriminated against for any of the following reasons?:   Race
Sex
Age
Disability
Pregnancy
Filing Worker's Compensation Claim
Injured on the job
"Blowing the whistle" on improper activity
Other
Please explain your above answer:  
Have you filed a Charge of Discrimination with the EEOC or any other agency?

   Yes No
Have you received a "Right to Sue" from the EEOC or any other agency?

   Yes No
If so, what is the date on your Right To Sue letter?:  
     
What specifically makes you think you were discriminated against?:

  

Did anyone in the workplace make comments about race/ sex/ age/ disability/ etc?

   Yes No
If so, who?:  
What were the comments?: (please use exact quotes if possible)

  
     
How long have you been employed with this employer?:  
Have you had any evaluations?:  
Were they generally good or bad?:  
Have you received any complaints or warnings about your work? If so, please describe:

  
     
Are you still working for this employer?

   Yes No
If no, have you found another job?

   Yes No
How much does it pay?:  
 
Additional Questions For Harassment Cases
If you have been harassed, please answer the following questions:
Name of Harasser?:  
Harasser Job Title?:  
Relationship To You?:  
Briefly describe exactly what the person said or did to harass you: (use exact quotes if possible)

  
Did you complain to anyone about the harassment?

   Yes No
To Whom?:  
When?:  
What was their response?

  
Was any action taken against the harasser?

  
 
How did you hear about our firm?:  
Do you have another attorney representing you at the present time?   Yes No
If so, who?:  
     
What would you like an attorney to do for you?

  
     
   
         
 

Personal Injury  |  Professional Malpractice  |  Wills & Estate Litigation  |  Unfair Trade Practices
Employment Discrimination  |  Civil Rights  |  Land Condemnation
Copyright © Glenn, Mills, Fisher & Mahoney, P.A. Durham, NC Attorneys at Law. Personal Injury, Professional
Malpractice, Unfair Trade Practices, Employment Discrimination, Civil Rights, Wills & Estate Litigation, Automobile Accidents, Auto Wrecks, Professional Negligence, Land Condemnation, Defective Products, Unsafe Property, Wrongful Death
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