Get in touch Contact Us (562) 228-0986 Contact Us Name(Required) First Middle Last Address(Required) Street Address Address Line 2 State / Province / Region ZIP / Postal Code Home Phone(Required)Cell Phone(Required)Email(Required) Date of Birth(Required) MM slash DD slash YYYY GenderMaleFemaleOtherCitizenship Were you referred to us?NoYesHow did you find about us? Who referred you to us? Name of Employer How many employees?Date of hire MM slash DD slash YYYY Job Title(Required) Most recent salaryUnion What harm (fired, laid off, demoted, reassigned or transferred unfairly, not promoted, not accommodated, reasonable request denied, etc.) was inflicted on you?What reason(s) did the employer give for taking the action(s) that it took?What do you believe are the real reasons your employer took these actions?Did You Resign?NoYesDid you ever complain to your employer about the harmful actions against you (either orally or in writing)?NoYesWhat Date MM slash DD slash YYYY To whom did you complain to? Explain why you are contacting JGL for possible representation by providing a summary of the reasons why you believe you were treated wrongfully by your employerDo you believe you were fired or harmed in some other way for taking a leave of absence?Have you ever filed a workers' compensation claim?NoYesDate MM slash DD slash YYYY If there is any other information that you wish to provide for JGL to assess your situation (including offers of severance or settlement), please provide below:Did you receive all your meal and rest breaks or are you salaried?Consent I agree to the privacy policy and disclaimer. Δ
