Employment Intake Form
Client Full Name
First Name
Last Name
What's the company name of your employer?
How many employees does your employer have?
How long did you work at this job?
What was your job title?
How much were you paid?
When were you terminated?
In what city do you live in?
Are you a union employee?
Has the company offered you separation pay or asked you to sign a severance agreement? If yes, how much and did you sign the agreement?
Please briefly explain what happened
Client's e-mail address
What's your best phone number?
Submit
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