Please completely fill out all of the information requested on this questionnaire. Every question with a * is required before the form can be submitted. We will use this information to assess the potential intake of your case. Some questions may seem personal, but this is important to understand how the conduct by the defendant would affect you and/or your family, and therefore becomes important in determining the value of any emotional distress claims you may have. ALSO, please use a separate document or email to write a description of the present dispute in chronological order. Please be as specific as possible, but it need not be perfect grammatically. Also, please use a separate document, resume, or email to provide your employment history. Please provide the approximate dates you worked for each employer, why you left, any discipline or positive award you received. You should email the employment history, description of the present dispute, and any supporting documents including pay stubs and the like to [email protected]. Please do not mail any original documents at this time. Please let us know if you have any questions as you work through this process. THANK YOU.