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Fair-workplace.com: Claim Questionnaire

If you would like us to consider representing you on a claim that your employer failed to pay you wages that you are owed, or for a claim involving wrongful termination, discrimination, harassment, overtime, reasonable accommodation of disabilities, family or medical leave, employee benefits, non-competition agreements or any other employment-related issue, we invite you to complete our questionnaire.

Disclaimer. Nothing on this web page is legal advice, as employment law is far more complicated than this broad, general outline would indicate. Also, your review of this web page and your contact with us does not create an attorney-client relationship. Attorney-client relationships with Ogden Murphy Wallace, P.L.L.C. and any of its attorneys are created only through a written fee agreement or letter from us confirming our representation. We are licensed to practice in Washington State so, if you have an issue in another jurisdiction, you will need to contact someone in your jurisdiction to help you. Please do not fill out this form if you know Ogden Murphy Wallace currently represents your employer and please be advised that, if there is a conflict of interest, we could end up representing your employer.

When you are finished filling out this form, please press Submit Form, fax it to Angela Hyde at 206-447-0215, or print it and mail it to Angela Hyde, 1601 Fifth Avenue, Suite 2100, Seattle, WA 98101.

Required fields have a red *

* Your Name		* Your Address
* Your Phone No.		* Your Email Address
* Employer		* Employer Phone Number
Employer Address
Job Title

* Description of Work you Do/Did

* Length of time at Employer?

* How many employees does your employer have?
0-8	8-25	25-50	More than 50

* Do you have a contract with your employer?
Yes	No

Are you a member of a union?
Yes	No

* Brief description of your employment problem (discrimination, harassment, unpaid wages etc.)

* What do you hope to gain through legal action? (E.g. get your job back, obtain back wages, obtain compensation for physical symptoms or emotional distress, to send a message to the company about how they treat people, etc.)

* Have you filed a complaint with the EEOC or the Human Rights Commission? When? What have they told you? What has been done on your complaint so far?

Thank you for completing our questionnaire. The data on this form will not be encrypted, and therefore is not necessarily confidential if emailed. If you are not comfortable with this, then you can mail us the form or call our intake coordinator, Angela Hyde, with the information and she will fill out the form for you. You can contact Angela Hyde by e-mail at ahyde@fair-workplace.com, by telephone at 206-447-7000, by fax at 206-447-0215, or by mail at Ogden Murphy Wallace, P.L.L.C., 1601 – 5th Avenue, Suite 2100, Seattle, WA 98101. We will need some time to review your answers to this questionnaire, and then we will get back to you. Generally, the review process takes 2-7 days.