Information About You

Previous Names or Aliases

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Source

Prior Lawsuits / Arbitrations

Bankruptcies

Criminal Convictions

Worker’s Compensation

Prior Employment

Public Information About You

PARTIES AGAINST WHOM YOU SEEK LEGAL ACTION

EVENTS THAT CAUSED YOU TO SEEK LEGAL ACTION

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OTHER ATTORNEYS YOU HAVE COMMUNICATED WITH

COMPLAINTS TO EMPLOYER

COMPLAINTS TO UNION

COMPLAINTS TO GOVERNMENTAL AGENCIES

RETALIATION FOR COMPLAINING

YOUR JOB WITH THIS EMPLOYER

Performance Evaluations

Termination of Employment

General Job Characteristics

Work Location
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Supervision
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Decision Making
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Hours
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Assignments
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WAGE & HOUR (MINIMUM WAGE, OVERTIME, MISCLASSIFIED AS EXEMPT, ETC.)

What were your usual working hours? (Start and end time, for example, 8:00 am. – 6:00 pm). Please state the hours you actually usually worked, not just what you were scheduled for.

What were your rates of pay, and when? (Estimates are okay.)

What were your rates of pay, and when? (Estimates are okay.)

If you received tips, did management take any part of your tips?

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For each job title you listed above, please generally describe the duties of that job:

If at any time you had any supervisory responsibility with your employer, describe, and when:

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BREAKS AND MEAL PERIODS

EMPLOYMENT-RELATED EXPENSES

VACATION PAY

DISCRIMINATION & HARASSMENT

WITNESSES & EVIDENCE

EFFORTS TO SEEK NEW EMPLOYMENT

EMOTIONAL DISTRESS

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I understand that I have provided the foregoing information solely for the purpose of having my case reviewed. I understand that the Glaser Labor Law, has made no decision whether to take my case, and is under no obligation to do so. I understand that submission of this information does not create an attorney-client relationship, and that if and only if my case is accepted, a written Attorney-Client Fee Agreement will be provided. Please bear in mind that, if you have time deadlines (or statutes of limitations) that are quickly approaching, we cannot guarantee that we will respond in time for us to assist you in filing a lawsuit or administrative agency complaint.

You should take immediate action to avoid missing any such deadlines. You may fax your questionnaire to (310) 626-4662. Or, mail it to: Glaser Labor Law 6475 East Pacific Coast Highway, Suite 1005, Long Beach, CA 90803 I certify that the information I have provided in this questionnaire and in any attached documents is true to the best of my knowledge and belief.

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If you have questions about this form, please contact a labor attorney at our law firm to assist you.

The affected employee’s age was over 40;
They were demoted, wrongfully terminated or not promoted to an open position;
They were not hired for the position despite having adequate qualifications;
The position was still open after their rejection, or the position was filled by someone younger than the affected employee.
It should be noted that a “prima facie” case is typically the bare minimum of evidence in an age discrimination lawsuit. Stronger evidence of discrimination, such as spoken preferences for younger employees or seemingly arbitrary downsizing patterns, can help your case.

What are the Legal Requirements for Claiming Age Discrimination?

Before you are able to pursue legal action against your former employer, you must file a claim with the Equal Employment Opportunity Commission. In California, your claim must be filed within 30 days of the discriminatory act, or you will lose your options for legal action. After the EEOC investigates your claim, you will be notified if you can pursue a lawsuit against the discriminatory company. In most cases, notification is given through a “Right to Sue” document.

Get Advice from an Age Discrimination Lawyer

An employment lawyer with significant experience handling age discrimination lawsuits can help you explore your rights and best options for legal action. Under California law, you can pursue damages and reinstatement if you were the victim of discrimination by an employer. Contact our office today to have your situation reviewed by qualified and experienced discrimination attorney.