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Do you understand that we are only investigating your possible case and that we will not represent you or take action on your behalf unless we hand-sign a written agreement explaining the scope of our representation?*

Yes
No

Sorry, we cannot take your information unless you understand this.

Do you work for a government employer (city, county, state, federal)?*

Yes
No

Sorry, but we do not represent employees of governments at this time, as different laws apply. Please seek counsel who represent government employees. You may want to do a search for "public employment lawyer."

Your Name*

Phone (with area code)*

Email Address*

Are you comfortable telling us the name of your employer?*

Yes
No, I'd rather not right now.

Name of the employer you are calling about*

In what city did you work for the employer?*

Were you a member of a union when you worked for the employer you are calling about?*

Yes
No

Size of employer*

Your most recent position title with the employer?*

How long employed by employer?*

Your most recent salary/hourly rate?*

Have you been terminated?*

Yes
Not yet

What was the date of your termination (include year)?*

Why did your employer say you were terminated?*

When do you think you will be terminated?*

What do you think is the true reason for termination? (If you believe it is discrimination or retaliation, please provide the kind of discrimination or retaliation--like is it because of race, gender, disability, age, or for making a specific complaint about something--what kind of complaint, etc.)*

What evidence do you have that the reason is what YOU think it is? (Comments, documents, etc.?)*

What reason do you think your employer will give for terminating you?*

Is the employer lying about the reason for termination? What part is not true?*

Have you ever been convicted of a felony?*

Yes
No

Have you ever sued an employer before?*

Yes
No

When and for what?*

We find that many employees do not know it, but they have earned overtime pay and have not been paid it. You may be entitled to overtime even if you were paid on a salary basis. So please answer these few questions about your pay.

Were you paid premiums (like time-and-a-half) for hours over eight in a day or forty in a week (again, even if you were paid a salary)?*

Yes
No

How much overtime (hours over 8 in day or 40 in a week) did you usually work in an average week?*

None worked
1-5 hours
5-9 hours
10 or more hours

If you were not paid overtime because you were treated as a salaried "exempt" employee, please briefly describe your usual job duties.

How old are you?*

There are about three other attorneys we work with who we know personally and who will sometimes take a case when we cannot for some reason. Can we have your permission to provide your information to these other attorneys via email if we cannot take your case and we think they could possibly be of help (we will tell them the information is confidential)?*

Yes
No

Sometimes we think a workplace injury attorney should review a case to see if there is a possible workers' compensation claim. If we think there is a possible stress injury or other claim involved in your case, do we have permission to share the information with our workers' compensation attorney colleague, David Tous, via email, to see if he can be of help?*

Yes
No

Would you like to add anything else?

Thank you very much. Please click "SUBMIT" and the information will be sent to us immediately for review.

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Perry Smith is the Lead Attorney for the TDR Law Group

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