Phone 248.354.9650
Fax 248.354.9656

Employment Law Intake Form

HOW CAN WE CONTACT YOU?

Your Name*
Address
Home Phone
Business Phone
Cell Phone
Email*

A LITTLE ABOUT YOURSELF

Race
Gender
Date of Birth
Age

YOUR EMPLOYMENT INFORMATION

Who referred you to us?
Employer
Address where you worked/work
HQ/Human Resources address
Phone
Date of Hire
Last Date Worked
Date of Termination
Date of Resignation

TELL US ABOUT YOUR CLAIM

Briefly describe your claim(s)

Are you represented by a union? If so, which?

Have you filed a grievance regarding the issue you are raising with this firm?
If yes, please describe the grievance and what has happened with it so far.

Have you received treatment from a health care professional regarding the issue you are raising with this firm? If yes, please provide the name of the practitioner, area of practice, address, dates of treatment, diagnosis if known and the treatment provided, e.g. medication prescribed. Have you had any history of similar health issues prior to the issue you are raising with this firm?

Have you ever been terminated from a job prior to the issue you are raising with this firm?
If yes, state the employer name and the year of the termination.

BACKGROUND INFORMATION

Have you ever filed for bankruptcy? If yes, what kind and when?
Is the estate closed / bankruptcy discharged? Who represented you in the bankruptcy proceedings?

Have you ever been involved in a lawsuit before? If yes, provide details below.

Have you ever been charged with or convicted of a crime? If yes, provide details below.

You should understand that if we file a lawsuit on you behalf, your background will be extensively investigated by the other side. Is there anything we should know about your history prior to agreeing to represent you? Is there anything that would be damaging or embarrassing that may be revealed?

UPLOAD RELEVANT FILES

Do you have notes/diary/journal/e-mail/correspondence regarding your claim(s)?
Do you have a written contract?
Do you have a personnel handbook or employee handbook?
Do you have a copy of your personnel file?
If yes, please upload them below. If you are having trouble uploading files here, please email them to info@michworkerlaw.com with "Intake Files for YOUR-NAME" as the subject.



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