California employees rights lawyers, wrongful termination

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Eisenberg & Associates

3580 Wilshire Blvd., Suite 1260
Los Angeles, California 90010

Phone:	(213) 201-9331
Fax:	(213) 382-4083

info@laborlitigators.com

To help us evaluate your case please answer the following questions as they pertain to the employer that you would like to take action against:

Were you a member of a Union?
Yes
No

Were you employed in California?
Yes
No

Were you fired?
Yes
No

If you were fired, what reason did the company give you for the firing? (even if you claim the reason is false)?

If you were fired, why do YOU believe that you were truly fired?

If you quit, why did you quit?

Did you complain about any conduct that you thought was illegal or unfair?
Yes
No

If you complained, please describe your complaints in detail.

If you complained, what was the last date you complained?

Were you fired while you were on medical or pregnancy leave?
Yes
No

If so, when did you start your medical or preganancy leave?

How much time did you take off in the last 12 months of your employment (and please state the specific reasons for each leave)?

Were you pregnant at the time of your termination?
Yes
No

Did your employer know you were pregnant at the time of your termination?
Yes
No

Do you feel that you were retaliated against after you complained about something illegal or unfair?
Yes
No

If so, explain:

What was your date of hiring?

What was your job title?

What is the name of your former employer?

What was your rate of pay when your employment ended?

Please describe all discipline against you (including date(s) of discipline, reason for discipline and what discipline was taken against you):

How many employees does the company have?

On what date were you fired/did you quit?

Were you paid for all overtime that you worked?
Yes
No

Briefly describe your job duties:

Please include any additional information that you feel is important to your case. Also, please state how often you received daily meal and rest breaks. Finally, please state the COUNTY in which you were employed.

You MUST list all of your contact information for us to get back to you:

Full Name:
Home Phone:
Work Phone:
Cell Phone:
E-mail:

This form is being provided to help Eisenberg & Associates determine if you have any legal claims against your former employer. By filling out this form and sending it to us, no attorney-client relationship is created.

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Eisenberg & Associates

Eisenberg & Associates

We Can Help You!