California Discrimination Questionnaire

Provided by Our Los Angeles Discrimination Attorneys

Kesluk & Silverstein Law Offices, LLC
3255 Sunset Blvd., Suite 411
Los Angeles, CA 90069
Tel. 310-273-3180
Fax. 310-273-6137
DougSilverstein@KandSLawyers.com
Info@CaliforniaLaborLawAttorney.com

If you have faced discrimination at work, whether it was racial discrimination, gender discrimination, or otherwise, our Los Angeles Discrimination lawyers may be able to help. Please eithercall our law firm or fill out the form below.

Name:*
Address:
City:
State:
Zip:
Phone:
E-mail:*
Were you fired?
If fired, when?
If not fired, do you think you are about to be fired?
When?
Were you given a reason for being fired/about to be fired? What reason?
Do you think it's really for a different reason? If so what reason?
Did you quit?
If yes, when did you quit?
If yes, why did you quit?
Were you or are you being harassed?
If yes, when was the last time?
If yes, what (briefly) constituted the harassment?
Why do you think you were being harassed? (race, age, gender, other - please name)
Did you report the discrimination or harassment to anyone in your company?
Who did you report it to?
What is their position?
Are they still employed there?
Did anyone witness the discrimination or harassment?
Who witnessed it?
What did they see or hear?
Are they still employed there?
Did you report the discrimination or harassment to any government agency?
Which agency?
When was it reported?
Did you file a written complaint?
Did you receive anything in writing notifying you that you can file a lawsuit?
When did you receive it?
Are you presently employed?
Where are you presently employed?
How long have you been employed?
What do you earn?
If you were fired or quit, how long were you there?
How much were you making?
Please indicate any other facts that you believe are important. We need to know what your employer did to you, what reason you think they did it which you believe it illegal, and what damage or loss you suffered because of what they did.
*
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California Discrimination Questionnaire

Provided by Our Los Angeles Discrimination Attorneys

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