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McKnight, Canzano, Smith, Brault & King, P.C.

Michigan Labor & Employment Law

Our Attorneys
Labor Practice
Employment Practice
Of Interest
Contact

Contact Us Today

Our Attorneys
Labor Practice
Employment Practice
Of Interest
Contact

Employment Law Intake Form

Tell us about your workplace concern so our attorneys can conduct a preliminary review.

Employment Law Intake Form

Employment Law Intake Form

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Contact Information

Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Country Phone Number

Email(Required)

Preferred contact method

Phone

Email

About You & Employment Information

Race

Gender

Date of Birth

Month

Day

Year

Employment Information

Who referred you to us?

Employer

Address where you work or worked

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Headquarters/Human Resources address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer phone

Country Phone Number

Date of hire

Month

Day

Year

Last date worked

Month

Day

Year

Current employment status

Currently employed

Terminated

Resigned

Other

Date of termination

Month

Day

Year

Date of resignation

Month

Day

Year

Tell Us About Your Claim

Important: Please do not enter information about your claim into a public AI tool to organize your facts. Doing so may jeopardize confidentiality or any privilege that could later be claimed.

Briefly describe your claim(s)(Required)

Are you represented by a union?

Yes

No

Which union?

Have you filed a grievance concerning this matter?

Yes

No

Describe the grievance and its current status

Have you received treatment from a healthcare professional related to this matter?

Yes

No

Please provide treatment details

Please include the practitioner’s name, specialty, treatment dates, diagnosis if known, treatment provided, and any history of similar health concerns.

Have you previously been terminated from another job?

Yes

No

Previous employer and year of termination

Background Information

Have you ever filed for bankruptcy?

Yes

No

Please provide the type, date and current status of the bankruptcy

Who represented you in the bankruptcy proceedings?

Have you previously been involved in a lawsuit?

Yes

No

Please provide details about the lawsuit

Have you ever been charged with or convicted of a crime?

Yes

No

Please provide details about the charge(s) or conviction(s)

Is there anything else in your history that we should know before considering representation?

If a lawsuit is filed, the opposing party may investigate your background. Please identify anything potentially damaging or embarrassing that could become relevant.

Supporting Documents

Which documents do you have available?

Notes, diary or journal

Emails or correspondence

Written employment contract

Personnel or employee handbook

Personnel file

Medical or treatment records

Disciplinary notices or performance reviews

Termination or resignation documents

Other relevant documents

Upload Supporting Documents

Upload copies of documents relevant to your employment concern. Files will be provided to the firm through secure links rather than attached to an email. If your files exceed these limits, the firm will provide another method for submitting them.

Drop files here or

Accepted file types: pdf, doc, docx, jpg, jpeg, png, xls, xlsx, Max. file size: 20 MB, Max. files: 10.

Consent(Required)

I understand that submitting this form does not create an attorney-client relationship. The firm has not agreed to represent me unless I receive and sign a written representation agreement.

I agree

Consent

I certify that the information I have provided is accurate to the best of my knowledge and authorize the firm to review it for the purpose of evaluating my inquiry.

I agree

CONTACT US
248-354-9650
248-354-9656 (Fax)
MAIN OFFICE ADDRESS
3950 W. 11 Mile Road Berkley, MI 48072
EMAIL
[email protected]
BUSINESS HOURS
Mon-Fri 9am- 5pm
Intake forms available on our website 24/7

Of Interest

Scabby the rat, the NLRA, and the First Amendment
August 25, 2021
Per Curiam Supreme Court of the United States
March 2, 2018
Protested the institution of so-called “Right to Work” in Michigan.
December 20, 2017
Your Rights, One Voice: Alicia and Darcie’s Story
January 29, 2016

*The information on this website is for general information purposes only. Nothing on this site should be taken as legal advice for any individual case or situation. This information on this website is not intended to create, and receipt or viewing of this information does not constitute, an attorney-client relationship.

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