Questionaire Form - Pasternak Law

Interactive Questionnaire for Employment Related Problems

NOTE: Using this interactive questionnaire does not prevent or eliminate you from having a live call with one of our attorneys. You can always ask for a free telephone consultation.

Confirm Employment(Required)

Does this matter relate to your employment?
Note: This can be current or past employment, and it doesn’t matter whether you were called an employee or an “independent contractor.”

Yes

We’re sorry, but this interactive questionnaire is exclusively for employment-related issues. If your matter is not employment-related, please contact us at 415-693-0300, or HERE for a free consultation.

Still There?(Required)

Are you still working for this employer?

Yes

Nature of Your Problem(Required)

Please choose one option most relevant to the issue with your current or past employer. If there is more than one issue or other factors we need to know, please include that at the end of this form.

Retaliated against for something I did or said

Discrimination

Refused disability accommodations

Wages

Harassment

Improper background check

Contract issues

Fired/Quit(Required)

Were you fired? (this includes being "laid-off" or "let go") Or did you quit? (leave voluntarily)

Fired

Quit

Wrongful Termination Case(Required)

Is that the focus of your inquiry? You feel there was something wrongful about your termination?

Yes

If your answer is No please select a different option from point 3. in order to proceed further into questionnaire.

Nature of Your Problem(Required)

Please choose one option most relevant to the issue with your current or past employer. If there is more than one issue or other factors we need to know, please include that at the end of this form.

Retaliated against for something I did or said

Discrimination

Refused disability accommodations

Wages

Harassment

Improper background check

Contract issues

If Fired(Required)

When was the date you learned you were being fired?

MM slash DD slash YYYY

Did they give you a reason for letting you go?(Required)

Did they give you a reason for letting you go?

Yes

Reason Given for Termination(Required)

Do you think the reason they gave was the real reason, just in terms of what motivated them to let you go?

Note: Answer “Yes” even if you think this was misguided or unfair; right now we’re just trying to figure out what their motive was.

Yes. They honestly believed the reason they gave me (though I disagree with the decision for other reasons)

No. I think the reason they gave was a false reason or “false cover” to hide another, true reason.

Real Reason for Termination(Required)

Why did they let you go?

Note: Again, we’re looking at it right now just based on their perspective. Even if you think they made a mistake, or didn’t understand, or something like that, please pick the option that best describes what they were thinking at the time.

Performance

Attendance

Reduction in force

Couldn’t perform work for medical reasons

Needed time off

Bad Fit/Personality conflict (example: the boss just didn’t like me)

No reason given

I had complained about something

Pretext Motive(Required)

What was the real reason they fired you?

If multiple options apply, pick the one you think was the primary reason.

Performance

Attendance

Reduction in force

Couldn’t perform work for medical reasons

Needed time off

Bad Fit/Personality conflict (example: the boss just didn’t like me)

Didn’t want to deal with my disability

I had complained about something

Unfair(Required)

If you feel this decision was wrong or unfair, please state (briefly) why:

Quit(Required)

Why did you quit?

Employer refused to provide you disability accommodations

Employer intentionally created or knowingly permitted intolerable working conditions

You felt discriminated against

Employer refused to provide time off

You were retaliated against for something you said or did

You felt harassed in the workplace

Retaliation - Cause(Required)

What action did you take that prompted your employer to retaliate against you?

Reported a violation of the law

Requested disability or religious accommodations

Opposed, reported, or participated in an investigation of workplace harassment or discrimination

Reported or tried to stop your employer from theft, fraud, or embezzlement of government funds

Retaliation - Retaliatory Action(Required)

What action did your employer take to retaliate against you?

Fired me

Demoted me

Reduced my salary or benefits

Changed my work schedule

Transferred or reassigned me

Denied me a promotion

Denied me a raise

Created an intolerable work environment, forcing you to resign

Constructive Discharge(Required)

Please describe the intolerable working conditions

Wages(Required)

What is your issue?

Unpaid bonuses

Paid less than another employee who does substantially similar work but is of another gender, race, or ethnicity

Salary equates to less than hourly minimum wage

Salary does not account for overtime worked

Discrimination(Required)

We understand that this was a bad fit, personality conflict, or similar with one or more others in the workplace. We need to examine the source of that problem. Why did this person or persons have a problem with you?

I don’t know

They just didn’t like me

My age (Only select if you are over 40)

My race

My gender

My religion

My sexual orientation

My military service

My political views

My national origin

My marital status

My color

Did this lead to an adverse employment action (termination, demotion, pay cut, etc)?(Required)

Did this lead to an adverse employment action (termination, demotion, pay cut, etc)?

Yes

What was done to you?(Required)

What was done to you?

Fired

Demoted

Reduced salary or benefits

Changed work schedule

Transferred or reassigned

Denied a promotion

Denied a raise

Other

When did this happen?(Required)

When did this happen?

MM slash DD slash YYYY

Harassment(Required)

If you feel you were harassed, what do you think was the motivation behind the harassment?

I don’t know

They just didn’t like me

My age (Only select if you are over 40)

My race

My gender

My religion

My sexual orientation

My military service

My political views

My national origin

My marital status

My color

Who harassed you?(Required)

Who harassed you?

Supervisor

Non-supervisor

Were you harassed more than once?(Required)

Were you harassed more than once?

Yes

When were you harassed?

MM slash DD slash YYYY

Please describe the harassment. Use as few words as possible; if there are multiple examples, just describe the worst thing that happened.(Required)

Please describe the harassment. Use as few words as possible; if there are multiple examples, just describe the worst thing that happened.

Improper Background Check(Required)

How did the company provide notice of the background check?

Verbally

In small pieces of information provided throughout several written documents

In one written document which provided limited or no information to the content of the background check

In one written document which informed you of the scope and nature of the background check

The company did not provide notice of the background check

Other

How many employees were subject to background checks?(Required)

How many employees were subject to background checks?

Did you provide written authorization for the employee to conduct a background check?(Required)

Did you provide written authorization for the employee to conduct a background check?

Yes

Contract Issues(Required)

Are you a CBA employee or part of a union?

Yes

Is your pay salaried or hourly?(Required)

Is your pay salaried or hourly?

Salaried

Hourly

What is the issue with your contract?(Required)

What is the issue with your contract?

Contract of previous job preventing you from finding new work/accepting a new job (Non-compete clause)

Contract requires you to work overtime with no overtime pay

You believe a term of your contract is unlawful

Other

Unpaid Bonuses

Do you have any documentation of your employer promising you a bonus which you were not paid? If so, please upload said documentation here.

Drop files here or

Max. file size: 256 MB.

Salary Issues(Required)

What is your salary?

How many total hours do you work per pay period?(Required)

How many total hours do you work per pay period?

How many of those total hours are overtime? Overtime is defined as any additional time spent working after 8 hours in a workday, 40 hours in a workweek, or six consecutive days in a workweek.(Required)

How many of those total hours are overtime? Overtime is defined as any additional time spent working after 8 hours in a workday, 40 hours in a workweek, or six consecutive days in a workweek.

Time Off(Required)

You selected that the reason you were let go (or the reason they said you were let go) was attendance or a need for time off. If there WAS an attendance issue or need for time off, select from the menu below the reason that best describes why. If that was the reason given but it was just not true that there was any attendance issue, select that option.

Time off or attendance issue because of my own pregnancy/childbirth/adoption

Time off or attendance issue because of spouse’s own pregnancy/childbirth/adoption

Time off or attendance issue because of my own disability/medical leave (other than pregnancy/childbirth/adoption)

Time off or attendance issue because of a relative’s disability/medical leave (other than pregnancy/childbirth/adoption)

Time off or attendance issue because of legal proceedings

Time off or attendance issue because of need for alcohol/drug treatment

Time off or attendance issue because of victim of a crime

There was no time off or attendance issue [go to Pretext motive]

Time off or attendance issue because of military service

Time off or attendance issue because of voluntary fire/law enforcement service

Time off or attendance issue because of jury duty

Time off or attendance issue because of religious practices

When did you first tell them you would need the time off?(Required)

When did you first tell them you would need the time off?

MM slash DD slash YYYY

How much total time off did you need?(Required)

How much total time off did you need?

Less than one day

1-14 days of work

11-30 days of work

Between 1 and 3 months

Between 3 and 6 months

Over 6 months

Unknown/Extended/Other

What reason did the employer give for refusing the time off/letting you go?(Required)

What reason did the employer give for refusing the time off/letting you go?

That you weren’t entitled to the time off

That you needed too much time

That it would cause the employer a hardship

That you did not have a firm return date

That the job was eliminated or restructured

Other

How long had you been with the employer?(Required)

How long had you been with the employer?

More than one year

Less than one year

Number(Required)

How many employees does the employer have at or near (within 75 miles) of your location?

Were you full time or part time?(Required)

Were you full time or part time?

Full time

Part time

Third Choice

Disability Accommodation(Required)

What did you need from your employer?

Adjusted schedule

Special equipment

Transfer to another position

Modify current position

Time Off

Other

We understand that the employer refused to give you what you needed. What reason did the employer give?(Required)

We understand that the employer refused to give you what you needed. What reason did the employer give?

Too expensive

No position available

Too much trouble/burden

Not required to

Other

What type of medical condition is this?(Required)

What type of medical condition is this?

Short-term

Long-term

Permanent

What, if any, accommodations did your employer provide?(Required)

What, if any, accommodations did your employer provide?

Proof of Intent(Required)

Why do you think this was due to your race, gender, religion, etc?

UntitledAre there any witnesses to your discrimination or harassment?(Required)

Are there any witnesses to your discrimination or harassment?

Thank you for your submission.

One of our attorneys will review it and get back to you promptly.

Your Name(Required)

Additional Factors(Required)

Please leave additional comments concerning any additional factors we need to know not already addressed in this form.

How would you like to be contacted(Required)

Phone

Text Message

Any from above

Email(Required)

Phone(Required)

Phone

Text Message(Required)

Text Message

Captcha

Name

This field is for validation purposes and should be left unchanged.

Interactive Questionnaire for Employment Related Problems

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