LAW OFFICES OF RAPHAEL A. KATRI

Los Angeles Employment Lawyers

CASE EVALUATION FORM



1. Contact: (Phone or Email)

Name and Additional Phone # (optional)

2. Employer: (General description will suffice)

3. # of Employees: (Approximate number will suffice)

4. Length of Employment:

5. Position:

6. Salary:

7. Do you contend you were wrongfully terminated? If so, provide the following information:
              A. Date of termination:

B. Position of person who terminated you:

C. What reason were you given, if any:

D. If you disagree with the reason given, what do you believe was the cause of your termination?

E. Are you re-employed yet?

8. Do you contend you have been harassed or discriminated against? If so, provide the following information:

A. Position of person who has harassed or discriminated against you:

B. Does this person harass or discriminate against you because of your age, sex (including sexual harassment), pregnancy, race, religion, national origin, disability, sexual orientation? If so, which one:

C. If this person does not harass or discriminate against you because of one of the categories listed above, please provide a brief statement as to why you believe this person harasses or discriminates against you:

D. Have you reported the harassment or discrimination to any supervisor or manager? If so, provide the following information:   

(1) Position of person receiving the complaint?   

(2) Date the complaint was lodged:   

(3) Was the complaint verbal or in writing:   

(4) Provide a brief description of your employer's response to your complaint:

    

(5) Did the harassment or discrimination continue after your complaint?
yes no

E. Have you received a right to sue letter from either the DFEH or the EEOC?
yes no

If so, when: 

9. Do you contend you are owed wages, commissions, or tips by your employer? If so, provide a brief description of why you believe this money is owed and the amount of money you contend is owed:
 

10. Do you contend you were improperly denied a medical leave? If so, provide a brief description of why you believe the denial was improper:
 

11. If your situation is not covered above, provide a brief description of facts relevant to your claim:


SUBMIT RESPONSES VIA EMAIL OR FAX TO THE LAW OFFICES OF RAPHAEL A. KATRI:   info@socallaborlawyers.com  or (310) 733-5644.

LEGAL DISCLAIMER:

This communication is an “Advertisement” as defined by the California Rules of Professional Conduct and California Business and Professions Code. No communication herein shall create an attorney-client relationship unless a separate retainer agreement is signed by an attorney and client. This material is for informational purposes only and not intended to provide legal counsel or legal advice to you. The act of sending electronic mail to this law office or any attorney employed thereby or making an submitting an online Case Evaluation Form does not alone create an Attorney-Client relationship. This office is under no obligation to respond to your messages; any such responses are provided solely as a courtesy.