630-730-8135
Free 30 Minute Consultations
Intake Form
Intake Form
To schedule a consultation, please complete and submit the below form and then schedule a consultation.
NOTE: Fields with a * indicate a required field.
How Did You Hear About Our Firm?
What Type Of Issue(s) Are You Having At Work (i.e. Sexual Harassment, Discrimination)?
If You Feel That You Are Being Discriminated Against, What Is The Basis (i.e. Gender, Sexual Orientation, Age, etc.)?
Name (First & Last) *
Current Address *
State *
Phone Number *
Email Address *
Date of Birth
Race
Disability Status
Religion
Employer Name *
Employer Address
Last Held Position
Rate Of Pay
Fringe Benefits (i.e. Company Car, 401(K), Health Insurance)
Did You Receive Any Bonuses?
Were You Allotted Any Paid Vacation?
Name Of Your Direct Boss/Supervisor
Approximately How Many Employees Are In IL? (If You Know)
When Did You Start Working For The Company
Last Date Of Active Work
Have You Been Terminated?
Date Of Termination
Employer’s Stated Reason For Your Termination
What Do You Believe To Be The Real Reason For Termination/Treatment?
Have You Requested A Copy Of Your Personnel File?
Are You A Part Of A Union?
Have You Filed Anything With Any Administrative Body (i.e. EEOC/IDHR)?
If Yes, What On What Date Did You File Your Charge?
If Yes, Have You Received A Notice Of Right To Sue And When Was It Was Issued?
Did You Complain To Your Employer About Your Situation? (Describe)
What Action Did Your Employer Take After You Complained?
What Are Your Expectations From Speaking With An Attorney/legal Action?
Would You Rather Have This Matter Resolved By Settlement Or By Trial?
Is There Anything Else You Think We Should Know?
The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.
I have read and understand the Disclaimer and Privacy Policy.
Talk to Jolianne Today
If you've been involved in a workplace injustice, call 630-730-8135 today for representation
NOTE: Fields with a * indicate a required field.
*
*
*
Safeguarding Your Rights
Call: 630-730-8135
