Background information How Did You Hear About Us?* Select Option Referral from another lawyer or other person Google Social Media Another way?
If you want to speak with a particular lawyer at our firm, please select that lawyer’s name below. If not, please skip this question Select Option Joseph D. Garrison Ethan A. Levin-Epstein Stephen J. Fitzgerald Nina T. Pirrotti Joshua R. Goodbaum Amanda M. DeMatteis Judge Jonathan E. Silbert Other
What practice area does this concern?* Select Option Employment, Workplace, or Civil Rights Criminal Defense and Non-Criminal Investigations (Outside the Workplace) Personal Injury or Work Injury Other / Unsure
Employment, Workplace, or Civil Rights Please select the scenario that best describes your situation. If you think more than one scenario applies, please select the closest scenario, and use the text box on the last page to provide additional information.* Select Option I was terminated from my job or expect to be terminated very soon. I have been sexually harassed or sexually assaulted at work or by someone with whom I work or used to work. I am experiencing or have experienced harassment, discrimination, retaliation, or a hostile work environment (other than sexual harassment) from my current employer, but I have not been terminated. I want help negotiating or understanding a new employment agreement. I am still employed, but I want help reviewing and/or negotiating a separation or severance agreement from my employer. I am considering a new job and want to discuss my non-compete or other restrictive covenant; or I have already accepted a new job and have been sued or threatened with a lawsuit by my former employer. I am on a medical leave (FMLA leave) or need help obtaining a medical leave. I have a disability or other medical issue and need help performing my job. I am not being paid or compensated fairly or am owed compensation, overtime, commissions, or benefits. My employer has breached a written or verbal contract, violated its policies and procedures (such as the employee handbook), or otherwise broken a promise between us. I was not hired for a job for which I applied. I was not selected for a promotion by my employer. I am being investigated by my employer. I am involved in a dispute with my business partners. I am a student with a concern about Title IX, sex discrimination, and/or sexual harassment or assault. Something else / I am unsure which category applies.
HWE other than sexual harassment Date of Hire* Select Option Select Date I’m Not Sure
Location of corporate headquarters* Connecticut U.S. state other than Connecticut Outside the U.S
Approximate number of employees* Select Option Fewer than 5 5-50 51-250 More than 250
What date were you terminated from that position?* Select Option Select Date I’m Not Sure
What was the earliest date you learned (orally or in writing) that you were going to be terminated?* Select Option Select Date I’m Not Sure
Did you resign from or voluntarily leave your employment?* Select Option Yes No
If you have your resignation letter, please upload a copy. [Whenever “upload” is mentioned, the link should be right there; we don’t want users to have to wait to upload until the end.]* Have you signed a separation agreement?* Select Option Yes No
Have you received a proposed separation agreement from your employer?* Select Option Yes No
Do you believe your termination was wrongful, unlawful, or unfair?* Select Option Yes No
Why do you believe your employer’s actions were wrongful, unlawful, or unfair? (Select all that apply.)* Select Option I was subjected to discrimination I was subjected to retaliation I was subjected to Disparate treatment I was subjected to severance offer
HWE reasons
Discrimination On what date were you first harassed?* Select Option Select Date I’m Not Sure
On what date were you last harassed?* Select Option Select Date I’m Not Sure
On what basis do you believe you are being harassed?* Select Option I am being subjected to discrimination I am being subjected to retaliation
On what basis were you subjected to discrimination? (Select all that apply):* Age Disability Marijuana use or cardholder status Marital Status National origin / ancestry Pension eligibility, healthcare expense, or other benefit Pregnancy or recent parenthood (including lactation needs) Race Religion Sex Sexual orientation and/or gender identity? Other
Retaliation On what basis were you subjected to retaliation?(Select all that apply)* Select option I engaged in labor organizing; discussed compensation, benefits, or workplace issues; or took other actions for the benefit of myself and my co-workers. I filed a workers’ compensation claim and/or got hurt on the job. I opposed or complained about discrimination or harassment against myself or another employee I refused to engage in conduct that I believed was illegal or unethical I reported, spoke out about, or “blew the whistle” on a matter of public concern (such as unsafe or illegal conduct). I requested or asked about a family and/or medical leave (FMLA) I requested or asked about a reasonable accommodation for my disability Other
Disparate treatment Did your employer give you a reason for its treatment of you?* Select Option Yes No
Do you feel that the reasons given to you for the treatment were false or insufficient?* Select Option Yes No
What do you think was the real reason for the treatment, and why do you believe that? If you saw or heard anything that led you to that belief, please describe.*
Did you ever complain about this treatment?* Select Option Yes No
Do you believe the employer violated its own procedures or policies in the action it took?* Select Option Yes No
Severance offer Have you received a proposed severance or separation agreement?* Select Option Yes No
Sexual harassment If you feel comfortable, please briefly tell us what happened, including the identity of the employer and the person who harassed you.
New employment agmt Have you already signed an agreement with this employer?* Select Option Yes No
Do you have a copy of the draft or proposed agreement?* Select Option Yes No
Severance agreement Have you received a proposed separation agreement?* Select Option Yes No
Non-compete Do you have a copy of the non-compete or other restrictive covenant that you signed?* Select Option Yes No
Which best describes your situation?* Select Option I am considering a new job and want to discuss my non-compete or other restrictive covenant I have already accepted or started a new job and have been sued or threatened with a lawsuit by my former employer
Non-compete – Considering New Job Have you received an offer of employment from a new potential employer?* Select Option Yes No
Have you received an offer letter?* Select Option Yes No
Non-compete – Already Started New Job / Being Threatened or Sued Have you been served with a lawsuit?* Select Option Yes No
Please upload a copy of the complaint.* Have you received a cease-and-desist letter or other written threat?* Yes No
Please upload any letters you have received* Please describe any threats that were made against you.*
FMLA Leave Which best describes your situation?* Select Option I am out on medical leave now I need help obtaining a medical leave Something else
Which best describes your situation?* Select Option I have not yet requested an accommodation My request for an accommodation has been denied Something else
Are you still employed by this employer?* Select Option Yes No
When did you separate from this employer?* Select Option Select Date I’m Not Sure
Which best describes your situation?* Select Option I am not being compensated fairly (for example, because I am being paid less than a person of a different sex or race who does comparable work). I have not been paid for all the hours I worked. I have not been paid overtime rates for working more than 40 hours in a week I am owed other compensation, such as a bonus or commissions I am being denied benefits, such as health insurance, disability payments, or pension payments Something else
Do you have coworkers who are facing the same or similar issues? Select Option Yes No I don’t know
This field is for (I have not been paid for all the hours I worked.).
Do you have coworkers who are facing the same or similar issues? Select Option Yes No I don’t know
This field is for (I have not been paid overtime rates for working more than 40 hours in a week.).
Do you have coworkers who are facing the same or similar issues? Select Option Yes No I don’t know
This field is for (d.I am owed other compensation, such as a bonus or commissions.).
When did this denial take place?* Select Option I’m Not Sure Select Date
Do you have coworkers who are facing the same or similar issues?* Select Option Yes No I don’t know
Are you still employed by this employer?* Select Option Yes No
When did you separate from this employer?* Select Option Select Date I’m Not Sure
Which best describes your situation?* Select Option My employer breached our written contract. My employer breached our verbal contract. My employer violated its policies and procedures. My employer broke a promise between us Something else
Do you have a copy of the contract?* Select Option Yes No
Do you have a copy of the relevant policy?* Select Option Yes No
Failure to Hire What was the earliest date you first learned (orally or in writing) that you were not hired?* Select Option I’m Not Sure Select Date
Failure to Promote What was the earliest date you first learned (orally or in writing) that you did not receive the promotion?* Select Option I’m Not Sure Select Date
Being Investigated Have you been interviewed in connection with this investigation?* Select Option Yes No
Is an interview scheduled?* Select Option Yes No
Are you out of work on any sort of leave?* Select Option Yes No
Dispute With Business Partners Approximately how many employees does the business have?* Select Option Fewer than 5 5-25 26-50 More than 50
What is the business’s approximate annual revenue?* Select Option Less than $500,000 Between $500,000 and $1 million Between $1 million and $5 million More than $5 million
Does the business have a written operating or partnership agreement?* Select Option Yes No
IX / Student Have you sought medical attention?* Select Option Yes No
Have you undergone psychiatric or psychological treatment as a result of your employer’s actions?* Select Option Yes No
Have you made a claim for Unemployment Compensation?* Select Option Yes No
Have you received all the salary, bonuses, vacation pay, commissions, or other compensation owed to you?* Select Option Yes No
Compensation Have stock, options, and/or another form of equity been a component of your compensation?* Select Option Yes No
To your knowledge, is your employer or its parent corporation experiencing financial problems?* Select Option Yes No
Terms and conditions of employment Was or is your employment governed by a written contract or agreement?* Select Option Yes No
Did you receive a letter at the time of your hire which set out the terms of your employment?* Select Option Yes No
Does your employer have a mandatory arbitration policy or require arbitration of employment disputes?* Select Option Yes No I don’t know
Have you received regular performance reviews from your employer?* Select Option Yes No
Have you received any awards or commendations?* Select Option Yes No
Union Are or were you a member of a union with this employer?* Select Option I am or was a member of a union with this employer. No, I was never a member of a union with this employer
Have you ever been an officer in this union?* Select Option Yes No
Have you filed a grievance involving this issue?* Select Option Yes No
Is the union providing assistance?* Select Option Yes No
Have you contacted other attorneys regarding your situation?* Select Option Yes No
Have you filed any complaints with the EEOC, CHRO, or any other governmental agency?* Select Option Yes No
Please upload a copy of the complaint you filed.* Have you filed a lawsuit about your situation?* Select Option Yes No
Please upload a copy of the complaint you filed.*
Past Litigation Have you ever taken legal action or made charges against this employer or a prior employer?* Select Option Yes No
Have you ever been involved in any previous litigation (civil or criminal) or arbitration?* Select Option Yes No
Other than the disputes you already described, have you ever been involved in any other legal dispute, insurance claim, accident claim, lawsuit, or anything similar (other than driving or parking infractions)?* Select Option Yes No
Which Scenario Best Describes Your Situation? WHICH SCENARIO BEST DESCRIBES YOUR SITUATION?* Select Option I am being investigated by a criminal law enforcement organization (e.g., a police department, FBI, State’s Attorney, U.S. Attorney, other state or federal government agency or department). I have been arrested or charged with a crime I am being charged with violating a high school or college’s Title IX rules or policies (e.g., against sexual harassment or sexual misconduct).
Personal Injury / Work Injury How were you injured?* Select Option I got hurt at work I got hurt outside of work I got into a car accident
What date did your injury occur?* Select Option I’m Not Sure Select Date
Have you received any medical treatment for this injury?* Select Option Yes No
Do you have any prior injuries to these body parts?* Select Option Yes No
Do you have any documents related to your injury (such as a police report or workplace injury report)?* Select Option Yes No
Other/Unsure Please briefly describe your situation and why you are contacting us.*
how you are hoping we can help. You can also use this box to provide any additional information you would like us to know.Alternatively, if you prefer, you can upload a narrative through the link below*
Thank you for submitting your questionnaire. Your submission is protected by the attorney-client privilege, and we will maintain the confidentiality of the information you provided here. We will do our best to respond to you promptly, regardless of whether we ultimately are able to be of assistance.
Please be aware, though, that submitting a questionnaire to us does not mean we are “your lawyers.” Because of the large number of potential clients who submit confidential questionnaires to us, we cannot be responsible for your legal rights unless and until you and we sign a formal retainer agreement.
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