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Name(Required)

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Contact Number

Email(Required)

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Address(Required)

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

Name of Employer:

Job Title:

Dates of Employment

Start Date

End Date

Nature of Your Case

Harassment (based on race, gender, age, disability, religion, sexual orientation, or other protected characteristic)

Discrimination (based on race, gender, age, disability, religion, sexual orientation, or other protected characteristic)

Retaliation (for reporting harassment, discrimination, or other unlawful conduct)

Other:

Details of Your Case

Please provide a brief description of your situation, including any relevant dates, events, and individuals involved. This will help us better understand the facts of your case and determine how we can best assist you.

Confidentiality:

We understand the sensitive nature of employment law cases, and we assure you that all information provided on this intake page will be kept confidential and protected to the fullest extent of the law.

Before You Submit:

Please review your information to ensure accuracy and click the "Submit" button below to send your intake form to our team. One of our experienced employment law attorneys will review your information and contact you shortly to discuss your case further. By submitting this form, you acknowledge that submitting this form does not establish an attorney-client relationship and that any information provided is not considered confidential or privileged until such time as an attorney-client relationship has been established. Thank you for considering Workplace Advocates to represent you in your case. We look forward to fighting for your rights as an employee.

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