Vanderpool Griffith LLP

401 B Street, Suite 2000
San Diego, CA 92101

Employment Questionnaire

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All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!

Contact Information

Contact information

Prefix

First name *

Middle name

Last name *

Date of birth

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Employment Information

Name of Employer:

Employer's Local Address:

Approximate # of Employees - LOCALLY:

Approximate # of Employees - NATIONWIDE:

Date of Hire:

Job Title:

Years in Present Position:

Salary/Hourly Rate of Pay:

Paid Overtime?

Is your position covered by a Union contract, whether you are a member or not?

Yes

Do you have a written employment contract?

Yes

Is there any Employment Handbook describing your employer's personnel policies or rules?

Yes

Have you ever reviewed the contents of your personnel file?

Yes

Does your employer do performance reviews or evaluations?

Yes

Case Details

Which of the following describes what has happened to you?

a. Terminated:

(include the date)

b. Demoted:

(include the date)

c. Denied Promotion:

(include the date)

d. Harassed:

(include the date)

e. Treated Differently Than Others:

(include the date)

f. Denied Leave of Absence:

(include the date)

g. Defamed:

(include the date)

h. Not Paid Overtime:

(include the date)

Additional Case Details

Did you employer give a "reason" for the action taken?

Yes

Are there any witnesses who you believe will support your view of what happened and why?

Yes

Unlawful Discrimination

How do you believe your employer has violated the law? Check all that apply.

Discriminated against me because of my ______________

Yes

Terminated me because I complained about improper or illegal activities or about discrimination or harassment of another employee.

Yes

Terminated me or refused to rehire me because of my pregnancy.

Yes

Terminated me unfairly.

Yes

Broke a promise or agreement.

Yes

Misrepresented the job or the compensation in order to get me to take the job.

Yes

Did nothing or not enough to stop ___________ from sexually harassing me.

Yes

Refused to let me take time off work when my child, spouse, parent or domestic partner was ill, or retaliated against me when I did.

Yes

Failed to pay me overtime.

Yes

Lied about me in giving a reference to a potential new employer by saying: ______________

Yes

Termination Information

If you were terminated from your employment:

Have you found another job?

Yes

Not Terminated

Miscellaneous Case Information

Have you filed a complaint about your employer's conduct with any state or federal agency?

Yes

Has your employer done the same thing to any other employee?

Yes

THANK YOU

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