Employment Wrongful Discharge Inquiry Form Please enable JavaScript in your browser to complete this form.Todays Date *Name *FirstLastAddress (Street, City, State, & Zip Code) *Email *Contact Phone Number *When is the best time to contact you, and how would you prefer we contact you?Name of employer (If you prefer, this information can be withheld at this time)Approximate number of employees working for this employer.Do you have any witnesses who will testify?Have you ever been written up or had a bad performance review? If so, please explainComplaint DescriptionWere you discriminated or retaliated against? If so, please explainDate of hire:Were you terminated? .Yes or NoYesNoIf so, what was the date of termination:Reason (or reasons) given by employer for your termination:If the above reason for termination is not true or the real reason, what do you think is the real reason for your termination?Last job title (or position)Union member?.Yes or NoYesNoHow did you hear about us?Google SearchYellow PagesAvvo.comSuperLawyers.comBestLawyers.comClient ReferralAttorney ReferralMessageSubmit