Client Intake Form (Page 2 of 9) in pdf

Client Intake Form - Employment Law…2 of 9

III. TERMS AND CONDITIONS OF EMPLOYMENT

1. Are you a member of a union with the employer? If yes, what is the union's name?

_________________________________________________________________________________

2. Are you a party to a contract? ( ____ ) Yes ( ____ ) No

3. Did you receive a letter at the time of your hire that set out the terms of your employment? If so,

please attach a copy. ( ____ ) Yes ( ____ ) No

4. Did you receive an employee handbook or personnel manual when you were hired or at some time

during your employment? ( ____ ) Yes ( ____) No If you did not receive one, does the company use a

manual or set of policies? How do you know?

_________________________________________________________________________________

5. Do you have copies of your performance evaluations? ( ____ ) Yes ( ____ ) No What ratings have

you received over the past five years? Please explain rating scale.

_________________________________________________________________________________

IV. PREVIOUS ACTIVITY

1. Have you filed a charge with the Equal Employment Opportunity Commission (EEOC)or the New

York Division of Human Rights? ( ____ ) Yes ( ____ ) No

If so, which organization did you contact? _______________________________________________

When did you file the Charge? ________________________________________________________

Did you receive a right-to-sue letter? ___________; if so, when ______________________________

Have

you

filed

lawsuit

about

this

claim?

(

____

)

Yes

(

____

)

If so, please attach a copy of the complaint.

V. DISCRIMINATION/HARASSMENT CLAIMS

1. During what period of time were you subjected to harassment and/or discrimination?

_________________________________________________________________________________

Client Intake Form Page 2