All fields are required Your personal information is not shared with anyone outside our law office and is used only to contact you in accordance with our privacy policy.

How old are you?
What is the name of your (ex)employer?
How long were you employed with your (ex)employer?
What was your most recent job title/position?
What was your annual salary?
What benefits, if any, did you receive as part of your employment?
Are you unionized?
Did you sign an employment agreement at the time of your hiring?
What reasons (if any) were given for your termination? Reasons for Termination:
Have you been offered a severance package? If so what are its KEY terms?Severance Package:
 Additional Comments:Comments:

We will usually confirm your appointment by email and telephone within a few minutes of receiving your form.  If you submit this form outside of business hours, we will confirm your appointment by email and telephone early the next business day.

This form is a request to meet a lawyer and the use of this form does not create a lawyer-client relationship between you and this law firm or any lawyers of this law firm. You should not provide us with unsolicited confidential information until there is a lawyer-client relationship. We look forward to meeting you and discussing your legal issue.