Fast, Free, Confidential San Diego Employment Case Evaluation Form

Alright, let's start off by telling us a bit about yourself...

Name *

Last *

Email *

Phone Number *

Can you work legally in the United States? *

Yes

No

Are you active, reserve, or retired military, police, or fire? *

Yes

No

Thanks, now tell us a little bit about the employer in question.

Employer's Name *

Witnesses *

What city and state is the employer located? *

How many employees does the employer have? *

Please tell us a little about your job…

When were you hired by the employer? *

What is the most recent job title you held with this employer? *

What was your most recent wage with this employer? *

Are you still working for the employer? *

Yes

No

Termination Status

When Did Your Employment End

Do You Have Any Details You'd Like To Add About How Your Employment Ended?

Ok, we need to know a few details about your case...

Do you have any evidence to suggest you were harassed or discriminated against because of your race, color, ancestry, national origin, religion, creed, age (over 40), disability (mental and/or physical), gender, sex (including pregnancy, childbirth, breastfeeding or related medical conditions), sexual orientation, gender identity, gender expression, medical condition, genetic information, marital status, or military or veteran status? If so, please explain.

Yes

No

Please Describe The Harassment Or Discrimination You Experienced:

Do you have any evidence to suggest you were retaliated against for a requesting reasonable accommodation, taking a leave of absence, or raising concerns of unethical or illegal activity, unsafe working conditions, or patient safety? If so, please explain.

Yes

No

Please Describe The Retaliation You Experienced:

Were you ever required to work off the clock for this employer? *

Yes

No

Work Off The Clock Explanation

Were you paid at least time and a half for all hours you worked over eight in a day or 40 in a week? *

Yes

No

Time and a half Explanation

Were you provided a paid 10 minute break for every four hours you worked? *

Yes

No

10 Minute Breaks explanation

Were you provided a 30 minute break for every five hours you worked? *

Yes

No

30 minute break explanation

Do you have any documents proving your case? *

Yes

No

Do you have any witnesses who will testify on your behalf? *

Yes

No

Alright, thanks for providing all that information, this is the last section you will have to fill out. Tell us about why you are contacting us…

What are you hoping we can accomplish for you? *

* How did you hear about us? (Check all that apply) *

Case Evaluation …
Fast, Free Employment Case Evaluation

Let’s Get Started!

Alright, let's start off by telling us a bit about yourself...

Thanks, now tell us a little bit about the employer in question.

Please tell us a little about your job…

Ok, we need to know a few details about your case...

Alright, thanks for providing all that information, this is the last section you will have to fill out. Tell us about why you are contacting us…

McCarthy Law

Let’s Get Started!

Alright, let's start off by telling us a bit about yourself...

Thanks, now tell us a little bit about the employer in question.

Please tell us a little about your job…

Ok, we need to know a few details about your case...

Alright, thanks for providing all that information, this is the last section you will have to fill out. Tell us about why you are contacting us…

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McCarthy Law