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Potential Client Questionnaire

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Name *(Required)
Address *(Required)
Gender
How many employees work for the company / employer *(Required)
Were you an employee or an independent contractor?
Are / were you a union member? *(Required)
Are you still employed with this employer? *(Required)
Has it been more than one year since the above events took place? *(Required)
Have you spoken to, met with, or corresponded with any other attorneys regarding the issue you wish to speak with us about?
Are you disabled? *(Required)
Have you ever requested an accommodation of a disability from this employer? *(Required)
Did you ever complain to your employer regarding their wrongful conduct? *(Required)
Do you have any witnesses or documents to help you prove your claims? *(Required)
Have you ever taken a leave of absence from work? *(Required)
Do you believe you were fired for taking a leave of absence? *(Required)
Are/were you paid overtime for working more than 40 hours per week or 8 hours per day? *(Required)
Are/were you given a 30 minute off-duty meal break for each 5 hours that you worked: *(Required)
Were you reimbursed for work-related expenses (cell phone, uniforms, mileage (other than commuting), travel, supplies, etc.)? *(Required)
Have you ever sued anyone before or been sued? *(Required)
Have you ever filed or are you thinking of filing for bankruptcy? *(Required)
Have you been convicted of a crime in the past 10 years? *(Required)
Have you ever filed a workers' compensation claim? *(Required)
Do you believe you were fired for filing a workers' compensation claim?(Required)
Have you found another job since losing the job in question? *(Required)

COMPLAINTS TO GOVERNMENTAL AGENCIES Section

Have you filed a complaint with the Department of Fair Employment and Housing (DFEH) or the Equal Employment Opportunity Commission (EEOC)? *(Required)
If yes, have you received a Right-to-Sue letter?
Have you filed a complaint with the Department of Labor Standards Enforcement ("DLSE"/the Labor Commissioner)? *(Required)
Did your employer have you sign an arbitration agreement, either as part of a handbook or given to you as a separate document? *(Required)
This field is for validation purposes and should be left unchanged.

Note: Although the information you provide to us on this form is confidential, completion and/or submission of this form to us does not create an attorney-client relationship between Shirazi Law Firm (the “Firm”) and you. No attorney-client relationship shall exist until you and the Firm make a mutual decision to work together and make a written agreement stating the specific terms of that attorney-client relationship. While this questionnaire does not create an attorney client relationship, your information will be confidential and privileged. We will not disclose your information and you may not be compelled to disclose your communications with us to anyone.

If you have time deadlines (or statutes of limitations) that are quickly approaching, we cannot guarantee that we will respond in time for us to assist you in filing a lawsuit or administrative agency complaint. You should take immediate action to avoid missing any such deadlines.

Practice Areas

Emanuel Shirazi is a 5 star lawyer. I would highly recommend Emanuel to anyone seeking legal representation that is fair, honest and will keep your best interest and unique needs at the forefront. Should the…

KELLIE LINDBACK

Mr. Shirazi is the best employment lawyer! I feel very grateful to have found him and worked with his team. He is very easy-going and well respected in his field. If I had to choose…

Julie Franco

Mr. shirazi is an excellent attorney. I did my research and came across him and I’m glad I did! He has excellent communication skills and is very knowledgeable in what he does. Overall happy with…

Bianca Ramirez

If you’re looking for an advocate to defend injustices done to you, please look no further. Emanuel worked diligently for over 5 years on my case. He never gave up on me. As a client…

Rhonda Stafford

Emanuel Shirazi has been a blessing from the very start of hiring him and his team. Mr. Shirazi is very knowledgeable, resourceful, and fair. He exceeded my exceptions and I gained more than expected within…

Melinda Camacho

Emanuel took excellent care of me throughout the entire legal process. As stressful as one may assume these matters can get, he was always prompt to answering my questions and dispelling any sprouting anxiety I…

Connor Lee

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Shirazi Law Firm, PC

office Location

9454 Wilshire Blvd
Penthouse
Beverly Hills, CA 90212

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Telephone: (310) 400-5891

Toll Free: (888) 908-7994

Fax: (888) 908-7359

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