Contact Us

Long Intake Form English

Name(Required)

(required)

Address(Required)

(required)

Home Phone

Highly recommended for communication

Cell Phone

(recommended)

Email(Required)

(required)

Date of Birth

(required)

Gender

(recommended)

Citizenship

(recommended)

Who referred you to AM+F ?

Please let us know if somebody referred you to our firm.
If you were not referred, how did you find out about us?

Preferred Attorney

(recommended)

Name of Employer(Required)

(recommended)

How Many Employees?

(recommended)

Date of Hire

(recommended)

Job Title(Required)

(required)

Most Recent Salary(Required)

(recommended)

Union

(recommended)

What harm (fired, laid off, demoted, reassigned or transferred unfairly, not promoted, not accommodated, reasonable request denied, etc.) was inflicted on you?

(recommended)

What reason(s) did the employer give for taking the action(s) that it took?

(recommended)

What do you believe are the real reasons your employer took these actions?

(recommended)

Did You Resign?(Required)

(required)

Did you ever complain to your employer about the harmful actions against you (either orally or in writing)? If yes, on what date(s) and to whom did you complain?

(recommended)

Explain why you are contacting AM+F for possible representation by providing a summary of the reasons why you believe you were treated wrongfully by your employer

(recommended)

Do you believe you were fired or harmed in some other way for taking a leave of absence?

(recommended)

Have you ever filed a workers' compensation claim? If so, when (dates)?

(recommended)

If there is any other information that you wish to provide for AM+F to assess your situation (including offers of severance or settlement), please provide below:

(recommended)

Comments

This field is for validation purposes and should be left unchanged.

Advice. Advocacy. Support.

Long Intake Form English

Talk to Us. We’re Here to Help. Hablamos Español.