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: