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Which of these best describes your employment law issue?
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Wrongful Termination
Failure to Pay Wages
Bullying / Harassment
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Please enter the name of your former employer:
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Please enter the city where you worked:
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Please select the state where you worked from the list below:
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How many employees worked at the company?
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0 - 15
16 - 100
100+
What was your job title?
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When did you start employment?
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It's ok to put in the date if you remember it (i.e. Sept 15, 2014), or something like "8 years ago in Sept", or "haven't started yet"...
When did you end employment?
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It's ok to put in the date if you remember it (i.e. Sept 15, 2014), or something like "8 years ago in Sept", or "haven't started yet"...
How were you paid?
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Hourly
Salaried
Please enter your hourly pay rate.
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Please enter your annual salary.
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Did you get lunch breaks?
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No
Did you get rest breaks?
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Yes
No
Gender:
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Male
Female
Other / Wish Not to Say
Race:
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Age:
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Tell us why you think you got fired:
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Be as detailed as you would like - there is plenty of space
Do you think your age, race or gender had anything to do with your termination?
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Yes
No
Why do you think your age, race or gender had something to do with your termination?
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Tell us why you do not believe you were fairly paid.
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Tell us about the bullying / harassment:
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Please enter as much detail as possible.
Do you believe the bullying/harassment is as a result of your age, gender or race?
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Yes
No
Why?
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Please enter as much detail as possible.
Tell us what happened:
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Please enter as much detail as possible.
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