Dhaliwal Law

505 Montgomery Street, Suite 1100
San Francisco, CA 94111

Thank you for contacting Dhaliwal Law. Please complete this form as candidly and thoroughly as possible, and ensure that you provide your personal, non-work contact information to preserve the confidentiality of our communications. We will contact you soon after reviewing your responses.

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Contact information

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First name *

Middle name

Last name *

Date of birth

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

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Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

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Phone numbers

Phone number

Type

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Preferred Contact Method

Text Messags

Yes, I agree to receive text messages from Dhaliwal Law at the phone number listed above. (Message frequency varies and may include messages to coordinate meeting scheduling and appointment reminders. Message and data rates may vary. Opt out at any time by replying “opt out.”)

No, I do not want to receive text messages from Dhaliwal Law.

Preferred Pronouns

If you are comfortable sharing, are there any identities that significantly shape how you see yourself? What are they?

Employer Name

How many employees work for this employer?

Employer Location (City, State)

Job Title

Date of Hire

Annual Salary or Hourly Earnings

Other Compensation (Bonuses, Commissions, Equity)

Did you sign an arbitration agreement with your employer?

Yes

I don't know

Are (were) you a member of a union?

Yes

Has your employer terminated your employment?

Yes

When were you terminated? Have you been offered a severance package? If you have been offered a severance package, have you been given a deadline to accept or decline? If yes, please provide the deadline. Have you attempted to negotiate a higher severance? If so, please describe your efforts, your opening demand, and your employer's response. Were you terminated in a lay-off or reorganization? Have you found new employment? If so, when did you start your new role, and how do your earnings compare to your prior role?

Not yet, but I am concerned that termination is imminent

Have you filed a complaint or charge against your employer with any government agency (such as the EEOC or the California Labor Commissioner)?

Yes

Have you requested a copy of your personnel file from your (former) employer?

Yes

Have you ever filed a lawsuit?

Yes

Have you ever filed for bankruptcy?

Yes

Have you been convicted of a felony?

Yes

Please describe your employment concerns or questions in a few sentences.

How were you referred to our law firm?

Friend or family member

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Online search or lawyer directory website

Bar Association

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THANK YOU

Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case. We will contact you as soon as possible with any updates.

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