Employment Intake Form

Collects a client's work background — employer, role, pay, termination details and any severance agreements. Built for law offices and advisors sizing up employment cases before the first consultation.

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Client full name

Nombre

Apellido

What's the company name of your employer?

How many employees does your employer have?

How long did you work at this job?

What was your job title?

How much were you paid?

When were you terminated?

In what city do you live?

Are you a union employee?

Has the company offered you separation pay or asked you to sign a severance agreement? If yes, how much and did you sign it?

Please briefly explain what happened

Client's email address

What's your best phone number?

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