1. What is your reason for contacting Pinsky Smith PC? 2. If you are looking to connect with a specific attorney, please indicate that person here. 3. What is the name and location of your employer? 4. How long have you been with the employer/dates of employment? If applicable, date of resignation/termination. 5. Approximately how large is the employer and about how many employees? 6. Is there union involvement with the employer at all? Briefly explain. 7. What was your last position? 8. What is the name and position of your supervisor? 9. How are you paid (salary, hourly, commission based, etc.)? 10. What is your annual income? 11. If you have been terminated or fear you will be terminated, what is the reason your employer has given you? 12. If different from the reason given by the employer, why do you believe you were (or will be) terminated? 13. If you believe you were targeted for any reason, on what basis do you believe you were targeted? 14. Do you believe you have been retaliated against? Yes No 15. Does your case involve sexual harassment? Yes No 16. Is there any deadline you are facing? When?