Potential Client Application

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.

I understand that I must submit a description of the present dispute and work history via email to [email protected] as described in the instructions above. * I have read the instructions above and understand. This field is required.
Name * This field is required.
Street Address * This field is required.
City, State * This field is required.
Zip Code * This field is required.
Birthdate * This field is required.
Marital Status * This field is required.
Children Ages
Have you ever been a party to any kind of legal proceeding? * This field is required.
If you answered yes to the question above, please provide the name of each action, how you were involved, the year each action was filed, and the outcome. Do not forget criminal, bankruptcy, divorce, workers compensation or small claims proceedings.
Have you commenced a worker's compensation action? * This field is required.
If so, please describe the nature of your injury and the status of your worker's compensation action.
Name and address of employer who you believe has acted improperly toward you. * This field is required.
Total number of employees (best estimate) * This field is required.
Total number of employees in California (best estimate) * This field is required.
Full name and title of any individual supervisor(s) employed by your employer who you believe has/have acted improperly toward you.
Full name and title of any other employee(s) employed by your employer who you believe has/have acted improperly toward you.
Please indicate the general nature of the reason why you are seeking advice and counsel from an employment lawyer. Please check all boxes that you think are applicable. * Other Denial of medical leave Late pay Misclassification Retaliation for refusing to engage in an unlawful practice Retaliation for reporting suspected legal violations Retaliation for reporting suspected discrimination or harassment Discrimination and/or harassment based on gender Discrimination and/or harassment based on race Discrimination and/or harassment based on disability (including pregnancy) Missed meal or rest breaks Unpaid wages Breach of employment contract This field is required.
If other, please the issue describe briefly
If you believe you have been wrongfully terminated, what is the reason you were given for your termination?
If you believe you have been wrongfully terminated, what do you believe to be the real reason you were terminated?
Last worked hourly rate or monthly salary * This field is required.
If paid by the hour, average hours worked
Annual income you earned last year * This field is required.
Annual income three years ago * This field is required.
Still employed by same employer? * This field is required.
If not, presently employed with any employer? * This field is required.
If yes, employer name and present income.
If no, are you making efforts to find another job? * This field is required.
If yes, please describe those efforts.
If no, why not?
How has the defendant(s)' conduct made you feel? * This field is required.
Have you sought professional help to deal with employer-caused stress? * This field is required.
If yes, please explain nature and duration of such help.
Please describe how the stress, anger, humiliation, or other emotional reactions to the employer conduct caused you to experience any physical problems, if that is the case.
Other than lost wages, have you experienced any other financial losses as a result of the employer's conduct (i.e., lost benefits, forced sale of things to address financial distress, etc.) (explain)
Has the employer's conduct caused damage to your credit as a result of the financial losses you have experienced? (explain)
Have you experienced any other losses due to the employer's actions that have not already been discussed in this application?
Do you belong to a union? * This field is required.
Have you filed a complaint with the California Department of Fair Employment and Housing or the EEOC? * This field is required.
Does your employment agreement or Employee Manual state that you are required to arbitrate claims against your employer? * This field is required.
Have you signed any documents upon termination of your employment, like a severance agreement or other exit interview documentation? * This field is required.
If yes, what did you sign (please provide a copy if you have one)
If non-exempt, were you paid for all overtime hours? * This field is required.
If non-exempt, were you given meal and rest breaks everyday as required by law? * This field is required.
Has your employer reimbursed you for any mileage expenses? * This field is required.
Were you required to use your personal cell phone for work purposes, but your employer did not pay for a part of the bill? * This field is required.
Has your employer paid you late or bounced your paychecks? * This field is required.
What do you want to achieve in this matter? * This field is required.
We may have missed asking you about something that you think is important. Please describe anything else you feel may be important to our consideration of your case.
How did you hear about this law firm? * This field is required.
I understand that the answers I give in this application will be relied upon by Castle Law: California Employment Counsel ("Castle Law") to assess whether or not it will take my case for legal representation, and the scope of that representation. * I agree This field is required.
ATTORNEY TIMOTHY DEL CASTILLO IS NOT MY ATTORNEY AND IS NOT TAKING LEGAL ACTION, OR ANY ACTIONS TO PROTECT MY INTERESTS, UNLESS AND UNTIL AN ENGAGEMENT LETTER IS SIGNED BY BOTH ME AND THE FIRM. * I agree This field is required.
Dated * This field is required.
Signed (Type Name) * This field is required.
Phone * This field is required.
Email * This field is required.

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