Employment Questionnaire

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Name

E-mail Address

Please enter a valid e-mail address.

Name of Your Employer and type of business?

How long did you work there?

What was your position?

How many employees work in the company?

What were your responsibilities?

What was your salary? Were any of these merit raises?

Did you ever receive a bonus with this company?

Does this employer have written personnel policies or procedures?

Did you ever receive an employee handbook? If not do they have a handbook?

Does the Company give performance evaluations and if so are the evaluations written or oral? Do you have copies?

How have your performance evaluations been and when was the most recent?

Did you have a written contract of employment with this company?

On this job were you ever given a warning?

Were you fired? When? Or did you resign? Did you give them written notice?

Briefly describe your situation (including relevant dates).

What do you think was the real reason for your termination and what facts lead you to believe this is the real reason?

Was there discrimination based on your race, age, sex, religion?

Have you filed a complaint with the EEOC, case #, or DFEH case #?

Before any adverse action against you did you ever make any complaints to higher management?

After any adverse action against you did you file a complaint or grievance? What was the outcome?

Were you a member of the union, what was the name of the union?

Do you have any witnesses? What are their names?

What other types of loss has this caused you or your family?

Have you sought any treatment?

Workers' Comp claim filed?

Do you have any documents that support your position? If so, briefly describe documents and dates.

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Contact Information Name

E-mail Address Please enter a valid e-mail address.

Phone

Brief description of your legal issue

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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.

The law office of attorney Anthony J. Poidmore is located in the Sacramento area, in Roseville, California. Mr. Poidmore serves clients from throughout the Central Valley, the San Joaquin Valley and the Gold Country Foothills in places including Sacramento, Roseville, Stockton, Davis, Woodland, Yuba City, Granite Bay, Auburn, Lincoln, Marysville, Placerville, Oroville, Chico, El Dorado Hills, Placer County, Sacramento County, Yuba County, Butte County, San Joaquin County, El Dorado County and Yolo County.

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