Jump To Navigation
Do I Have a Case

Please take your time to answer the following questions as accurately and completely as possible. Please answer all questions that may apply to your situation. If a question is inapplicable, simply write N/A. Feel free to attach additional pages if necessary. At the end of the questionnaire there is additional room to supplement your answers or to add any additional information you think is relevant to your potential claim. While some questions may overlap or appear duplicative, they are necessary for organizational purposes.

By submitting this questionnaire, you acknowledge that you understand that you are submitting this information to Kleiman Lawrence Baskind Fitzgerald LLP for consideration only. The Firm is not establishing an attorney client relationship with you for purposes of reviewing this information and is under no obligation to represent you in this matter. You understand that the Firm may not take the case which you have requested that the Firm review.

NOTE:  An Asterisk (*) Indicates REQUIRED Information.



Date of Incident:
Deadlines you face:
*Name:
Address:
City, State, Zip:
*E-mail Address:
Phone Number:
Fax Number:
Mobile phone number:

EMPLOYMENT INFORMATION

Name of Employer:
Number of Employees at the Company:
How long you have worked there?:
Date of Hire:
Date of Termination:
Salary, total compensation and job benefits:
Job Title:

Brief Description of Job Duties:

Did you take or keep any confidential company documents or company property?

Did you send in a resume or fill out a written job application for this position? If you did, please provide an explanation of any misstatements, material omissions or inaccuracies in the information provided on the resume or application:

COMPLAINT INFORMATION

Date of Termination or other Adverse Employment Action:
Name of Person who notified you of termination:
Stated Reason for termination or other adverse employment action:
What do you believe is the real reason for your termination?:
Were you given any severance pay?:
Have you signed a release or waiver?:

Were you replaced? If so, please provide the name, age, gender and race of your replacement:
Have you found other employment yet?:
Were you demoted?:
Were you denied a promotion?:
Were you refused a job that you applied for?:
Does your employer have a mandatory arbitration policy?:
Did you get paid a salary or an hourly rate?:
Did you receive overtime compensation?:
Do you believe that you might be entitled to seek overtime compensation?:
Do you believe that you were paid the same amount as others were paid for comparable work?:

WRONGDOING BY YOUR EMPLOYER

Does your case involve any of the following wrongdoing by the company:

Type of Wrongful Action  
Age Discrimination:
Sex discrimination:
Sexual harassment:
Race Discrimination:
Libel or slander:
Breach of Contract:
Disability Discrimination:
Firing for refusal to commit an illegal act:
Firing for filing a workers compensation claim:
Overtime claim:
Equal Pay Claim:
Whistleblower:

Other (please specify):

NARRATIVE OF YOUR COMPLAINT


Briefly describe your main complaint:

ADMINISTRATIVE PROCEDURES

Date of filing of EEOC or TCHR charge:
Date (if applicable) of Determination or Right to Sue letter from EEOC or TCHR:

What deadlines do you face, if any, with respect to your need for legal advice? Please explain briefly:
Where did you hear about this website?
Today's Date:

Please note:

E-mail communication by you through this website does not establish an attorney-client relationship with Kleiman Lawrence Baskind Fitzgerald, LLP. We cannot agree to maintain the confidentiality of information and communications sent through this website. Please do not send us any information about your legal problem. If you are seeking legal representation, please fill out a questionnaire from the website. Our professional obligations require that before accepting any new client or new matter, we must determine whether there are any actual or potential conflicts with any of our existing or former clients. If you wish to inquire into becoming a client of the firm, please request a personal interview with one of our attorneys. We will not consider any e-mail or other communication regarding new client representation other than a request for a personal interview. This email is not confidential and is not protected by the attorney-client relationship. No attorney-client relationship is created by sending this e-mail. You do not become a client of Kleiman Lawrence Baskind Fitzgerald, LLP by sending this email.

To contact an attorney via email, please use this link, or close notice.

Kleiman Lawrence Baskind Fitzgerald LLP | 8350 North Central Expressway, Suite 650, Dallas, Texas 75206 | Directions and Map