LitiGator – Intake
IntroContact InfoEmployment DetailsIncident DetailsWork HistoryMedical HistoryTimelineDocumentsReview & SubmitFields marked with * are required.Welcome. Once you have provided us with the information we need to review your case, we will respond as soon as possible as to whether we are able to assist you. This form does not create an attorney-client relationship and we are not agreeing to represent you by you filing out this form. We will not monitor any deadlines for you or provide you legal advice unless we agree in writing to represent you.Begin Case ReviewFirst Name *Last Name *Preferred PronounsPhone *Email *Address *City *State *— Select —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip *How did you hear about us?Employer / Entity Involved *Brief Summary of Your Employment Matter *PreviousNextEmployer AddressCityState— Select —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZipDid you sign an arbitration agreement?— Select —YesNoI Don't KnowApproximate Number of Employees— Select —1–67–100101–200201–499500+Your Job TitlePay Amount (hourly or salary)Years EmployedAre you still employed there? *— Select —YesNoI Don't KnowHave you filed for unemployment?— Select —YesNoDate FiledDid you receive unemployment?— Select —YesNoDid you appeal the denial?— Select —YesNoDetails of Unemployment DenialUpload Unemployment DocumentsSelect FilesMax 5 files, 10MB each. Accepted: pdf,doc,docx,jpg,jpeg,png,gif,txt,rtf,xls,xlsx,csvHave you applied for other jobs?— Select —YesNoPreviousNextDo you believe you experienced discrimination?— Select —YesNoI Don't KnowBasis of DiscriminationRaceColorNational OriginSex / GenderAge (40+)DisabilityReligionPregnancySexual OrientationRetaliationOther Basis of DiscriminationDescribe the DiscriminationAge, Sex, and Race of CoworkersAge, Sex, and Race of SupervisorsHave you filed an EEOC charge?— Select —YesNoDid you receive a Right to Sue letter?— Select —YesNoDate of Right to Sue LetterEEOC Charge DetailsHave you already filed a lawsuit?— Select —YesNoDid you report any illegal activity at work?— Select —YesNoDescribe the Activity You ReportedHow did your employer retaliate?PreviousNextWere you terminated? *— Select —YesNoDate of TerminationUpload Termination LetterSelect FilesMax 3 files, 10MB each. Accepted: pdf,doc,docx,jpg,jpeg,png,gif,txt,rtfWere you ever suspended?— Select —YesNoSuspension 1×Date of SuspensionLength of SuspensionSuspended By (Name)Reason for SuspensionResolutionAdd SuspensionUpload Suspension DocumentsSelect FilesMax 5 files, 10MB each. Accepted: pdf,doc,docx,jpg,jpeg,png,gif,txt,rtf,xls,xlsx,csvWere you placed on a Performance Improvement Plan (PIP)?— Select —YesNoReason for PIPDate of PIPPIP Overseen ByUpload PIP DocumentsSelect FilesMax 5 files, 10MB each. Accepted: pdf,doc,docx,jpg,jpeg,png,gif,txt,rtf,xls,xlsx,csvPIP ResolutionDid you receive performance reviews?— Select —YesNoPerformance Review DetailsUpload Performance ReviewsSelect FilesMax 5 files, 10MB each. Accepted: pdf,doc,docx,jpg,jpeg,png,gif,txt,rtf,xls,xlsx,csvDid you receive any write-ups?— Select —YesNoWrite-Up DetailsUpload Write-Up DocumentsSelect FilesMax 5 files, 10MB each. Accepted: pdf,doc,docx,jpg,jpeg,png,gif,txt,rtf,xls,xlsx,csvWere you required to work without pay?— Select —YesNoDescribe the Unpaid WorkPreviousNextDid you take FMLA or medical leave?— Select —YesNoLeave Period 1×Date of LeaveDays MissedReason for LeaveAdd Leave PeriodDoes your employer offer paid sick leave?— Select —YesNoI Don't KnowDid you receive a sick leave notice?— Select —YesNoWere you retaliated against for taking sick leave?— Select —YesNoDescribe the RetaliationPreviousNextPlease list the key events in chronological order. Include dates (even approximate) and describe what happened at each point.Event 1×Date of Occurrence Approximate Date?What Happened?Add EventPreviousNextUpload Additional DocumentsSelect FilesMax 10 files, 10MB each. Accepted: pdf,doc,docx,jpg,jpeg,png,gif,txt,rtf,xls,xlsx,csvDo you know of any witnesses? *— Select —YesNoWitness 1×First NameLast NamePhoneEmailWitness StatementAdd WitnessPreviousNextPlease verify your contact info:Please verify your contact informationSubmit Case ReviewPrevious
Fields marked with * are required.
Welcome. Once you have provided us with the information we need to review your case, we will respond as soon as possible as to whether we are able to assist you. This form does not create an attorney-client relationship and we are not agreeing to represent you by you filing out this form. We will not monitor any deadlines for you or provide you legal advice unless we agree in writing to represent you.
Max 5 files, 10MB each. Accepted: pdf,doc,docx,jpg,jpeg,png,gif,txt,rtf,xls,xlsx,csv
Max 3 files, 10MB each. Accepted: pdf,doc,docx,jpg,jpeg,png,gif,txt,rtf
Please list the key events in chronological order. Include dates (even approximate) and describe what happened at each point.
Max 10 files, 10MB each. Accepted: pdf,doc,docx,jpg,jpeg,png,gif,txt,rtf,xls,xlsx,csv
Please verify your contact information