Meeting Request Form

If you are interested in meeting with one of the attorneys at Schleier Law Offices, we will need to get some information from you. We ask that you submit the information about your potential case so that we may assess the merits of your claim and determine whether Schleier Law Offices will be able to represent you. Please provide as much detail as you can in the form below. Additionally, you can call our office and speak with a staff member and provide the same basic information for the attorneys to consider.

In completing this form, you acknowledge that Schleier Law Offices is not offering to represent you at this time or accepting any duty or responsibility to represent you in a lawsuit, mediation or any other legal matter. After receiving the initial information, we will notify you whether we are interested in a follow-up conversation or meeting to discuss possible representation of your case. Your communications during this evaluation process will be treated as privileged and confidential.




Contact Information

First Name: Last Name:
Street: City:
State: Zipcode:


Telephone Number:

Cell: Email Address:

 

Current/Former Employer
Name and Location (City & State):
Number of Employees:
Length of Employment with Employer:
Profession/Job Title:

 

Background Information

What type of case do you have?
(check as many as apply)
Breach of contract
Wages
Termination
Demotion
Failure to promote
Discrimination
Harassment
Retaliation
Whistleblowing
Other
Let us know why you are seeking
legal assistance ?
Please provide the date the most
recent wrongful event occured
Have you filed a charge of
discrimination with the EEOC or the Arizona Civil Rights Division?
Y N
Has a determination been issued?
Y N
If yes, when was the determination
issued?
Has a Right to Sue Letter been
issued?
Y N
If yes, then when was the Right to
Sue issued?
Do you have a copy of any agreement?
Y N

Additional questions about your claim

What was your salary/hourly wage
with the employer in question?
If the case involves a loss of
wages, commissions, bonuses, what is the total you believe is owed to
date?
If the case involves a termination,
how long have you been unemployed?
If reemployed, what is your current
salary/hourly wage?
Have the events described above
caused you any emotional distress?
Y N
Have you sought any counseling or
medical care?
Y N

Referral source

The following information is for
our law firm’s use. How did you hear about Schleier Law Offices?
Personal referral
Attorney referral
Article
Speaking engagements
Search engine/portal
Yellow pages
Bar associations
EEOC referral
Other
If you selected Personal or Attorney Referral please include the name below: