Current or Former Employer
Were you fired?
When were you fired?
What reason were you given for termination?
If you think the reason for termination is wrong, what do you feel is the real reason for termination?
Did you resign?
When did you resign?
Why did you resign?
Have you been harassed or discriminated against because of your membership in a protected class (race, religion, creed, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, gender, gender identity, age, sexual orientation or military and veteran status)?
Please briefly describe the harassment and/or discrimination.
Who harassed and/or discriminated against you (identify name & job title)?
When was the last time that you were harassed and/or discriminated against?
Did you report it to the company?
Did anyone witness the harassment and/or discrimination?
Have you been retaliated against for (select one) No, I was not retaliated against.Blowing the whistle of illegal conduct?Refusing to engage in illegal conduct?Complaining about discrimination and/or harassment?Engaging in protected activity (taking family or medical leave, taking time off to vote or serve on jury duty, etc...)?
Who retaliated against you?
Please indicate any other facts that you believe are important. We need to know what your employer did to you, why they will say they did it to you, why you believe it is illegal, and what damage or loss you suffered because of what they did.