Call : (415) 391-7555

Call : (415) 391-7555

Call : 415-391-7555

Ready To Fight For Your Rights And Interests

Potential Client Intake Form

Please be advised: You are submitting information to be reviewed by our office. Although we will keep your information confidential, we cannot take any responsibility for your case until we have accepted the case, and you have a fee agreement signed by a partner in our firm. We only represent plaintiffs. Therefore, you should not have to worry about any conflict if your matter involves suing a corporation or an employer. We will get back to you as soon as we can. If you have any questions, please feel free to call us at (415) 391-7555. 

Please contact our office at 415-391-7555 if you are unable to fill out this form due to a disability, or if describing your case will require discussing exceptionally sensitive information (i.e. you experienced a sexual assault or were subjected to discrimination on the basis of your AIDS/HIV status). 

Intake Form

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Name*
Current Address*
Did you quit another job to take this job?*
Do you belong to a union?*
Did you sign an arbitration agreement when you were hired?*
If terminated, were you offered severance?*
Are you currently re-employed?*
Were any other employees terminated or laid off at the same time?*
Did you feel that the situation or the termination was based on any of the following types of discrimination? (please check all that apply)*
Have you filed with the E.E.O.C. (Equal Employment Opportunity Commissions), CRD (Civil Rights Dept.) or any other organization?*
Are you currently a named party in a lawsuit (do not include lawsuits where you were a beneficiary of a class action unless you were a named plaintiff)?*
Are you currently in bankruptcy or contemplating filing for bankruptcy in the near future?*
Have you filed with the E.E.O.C. (Equal Employment Opportunity Commissions), CRD (Civil Rights Dept.) or any other organization?*

PLEASE READ THIS IMPORTANT INFORMATION REGARDING WHAT YOU NEED TO KNOW TO AVOID LOSING YOUR RIGHT TO SUE:

Note: There are statutes of limitations in California. They are typically 300 days for the EEOC, and 1 year from the date of discharge or illegal conduct in California. You may need to file a union grievance immediately. If you work for the government, you may need to file earlier or file a claim within 6 months. A failure to file on time may result in the loss of valuable legal rights.

WE DO NOT REPRESENT YOU UNTIL YOU HAVE A SIGNED FEE AGREEMENT WITH A PARTNER IN OUR FIRM.