Disability Discrimination/Wrongful Termination Questionnaire

    Were you fired after notifying your employer about a medical diagnosis or injury?

    Did your employer tell you that your diagnosis/injury played a part in their decision to terminate your employment?

    When was your last day of work?

    Did your diagnosis/injury require a leave of absence for treatment?

    Did you have an estimated date for returning to work?

    Did your employer fire or demote you when you returned from the leave of absence?

    Were you told your position was no longer available after your leave of absence?

    Were you offered a similar position within the company? (required)

    Did your employer refuse to make accommodations for your diagnosis/injury? (For example, were you told that you could not perform your required job duties if you could not lift heavy weight, stand for extended periods, needed adjustments to in office schedule.)

    What accommodations were refused? (select all that apply)

    Did your employer make temporary job duty modifications for other injured employees?

    Did your employer deviate from their usual procedures in your case? For instance, your manager cited performance issues as the reason for your termination. Yet, the company gave other employees with performance issues written warnings and a chance to improve before firing?

    Did your employer state they were terminating your employment because you lacked a specific skill set?

    Please indicate any other facts that you believe are important. For example, we need to know what your employer did to you, why they will say they did it to you, why you think it is illegal, and what damage or loss you suffered because of what they did.

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