Client Intake Form (Page 4 of 9) in pdf

Client Intake Form - Employment Law…4 of 9

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9. What do you think is the real reason for the treatment? What evidence do you have to support your

belief?

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10. Did anyone witness the incident(s) described above? If so, state the name of the individual who

witnessed each incident.

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11. With whom have you discussed the incident(s)?

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12. Describe how you informed your spouse and family of the harassment/discrimination. Did you tell

them immediately?

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13. How many of your co-workers do you believe knew about your situation? How did they find out?

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14. Have you previously been subjected to harassment or discrimination by the individual(s) identified

in your response to questions no. 2? If so, please describe each prior incident in detail. (Include

names, dates, and locations. Try to describe the "who, what, when, where, why, and how" of the

incident(s). Attach extra pages if necessary.)

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Client Intake Form Page 4