About Your Potential Case</font>

About Your Potential Case

(*Indicates Required Field)

CONTACT INFORMATION
Full Name*:
Email Address*:
Have confirmation of your email sent to you?
Address*:
City*:
State*:
Zip-Code*:
Home Phone: (Include Area Code)
Work Phone: (Include Area Code)
Cell Phone: (Include Area Code)
 
EMPLOYMENT INFORMATION
Name of Employer*:
Address of Employer:
Type of Business:
Number of Employees: (Approximate)
Job Title:
Date of Hire: (Approximate)
Annual/Hourly Income: (Approximate)
Last Date of Employment: (If applicable)
Current Employment Status*:
Are you a member of a union?
   If yes, have you reported your problem to your union?
Did you sign an artibtration agreement?
   If yes, do you have a copy?
Did you receive performance evaluations?  
   If yes, do you have copies?
 
ABOUT YOUR EMPLOYMENT PROBLEM
What is your employment problem?*  
When did this problem begin? (Approximate)
 
DISCRIMINATION
If you are being illegally discriminated against,
please identify the basis of discrimination: 
   Your discrimination case details (age, disability, race, etc.)
 
OVERTIME
Approximately how many hours of unpaid overtime do you believe
you are entitled to over the past four years? (If applicable)
 
How do/did you track your unpaid overtime hours?
 
Are other employees at your workplace also being denied overtime? 
   If yes, approximately how many other employees?
 
If you have a claim for unpaid overtime, have you filed
a claim with the Division of Labor Standards Enforcement (DLSE) /
Labor Commissioner?
   If yes, when? (Approximate)
 
GENERAL INFORMATION
Is the person you are experiencing problems with,
the same person who hired and/or promoted you? 
 
Have you reported your problem to a government agency?
(For example, the EEOC or DFEH or DLSE)
 
How did you hear about The Law Office of Greg Mayeda?

Additional information about your potential case:
Please use this area to include any additional information about your potential case not asked above.

If you have ever filed a lawsuit, please briefly describe here:
Please include the type of lawsuit, when it was filed, the outcome, etc.


Optional File Attachment:


The Law Office of Greg Mayeda
410 Twelfth Street, Suite 325
Oakland, California 94607
info@mayedalaw.com
Phone (510) 420-1400
Fax (510) 291-9694
www.MayedaLaw.com


All information submitted will be treated confidentially.
Submitting this information does NOT create an attorney-client relationship.
By telling me about your potential case, you acknowledge that
The Law Office of Greg Mayeda has NOT agreed to represent you.
An attorney-client relationship with The Law Office of Greg Mayeda
will only be created upon the signature of a
written agreement by the attorney and the client.