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Handling cases across the state of Georgia

Employment Questionnaire

Employment Questionnaire

Please answer the following questions as thoroughly as possible. Please note that not all of these questions may apply to you. If they do now, Please put N/A in the space provided for that particular question.

Full Name* Date of Birth* Race* Gender* Sexual Orientation*

Pregnant?*

If yes, when is your due date?*

Mobile Phone* Personal E-Mail*

Do you suffer from a disability?*

If yes, please describe?*

Employment Information

Employer* Your Position/Title* How many employees does the company employ?* How long have you been employed there?* Address where you work*

Who do you report to?*

What is their title?*

What supervisor's telephone number?* What is your supervisor's email address?* How are you paid (Salary or Hourly)* What was your most recent salary/hourly rate?*

Did you ever receive a job description for your job?*

If yes, do you have a copy?*

Have you ever been disciplined at work (oral or written warnings, etc.)?* If yes, please explain:

Employment Issues

Please describe, in as much detail as possible, the problems you are having at work:

Prior Employment Claims

Have you ever made an employment claim or complaint with any previous employer? * If yes, please explain: Have you ever filed an EEOC charge previously? * If yes, please explain: Have you ever been a party to a lawsuit?* If yes, please explain: Have you ever been fired from a job?* If yes, please explain:

If you have any of the following documents, please provide us with copies:

Paystubs
W-2s
Job Description
Employee Handbook
Employer Policies / Procedures
Relevant recordings (audio or video)
Relevant photographs
Relevant Emails
Relevant Text Messages
Complaints made to employer
Written discipline you received

Please contact us at 770-720-4600 if you have any questions about this form.

Disclaimer: By checking this box, I understand submitting this form to Geiger Legal Group, LLC, it does not by itself create an attorney-client relationship or constitute the provision or receipt of legal advice. This questionnaire form should be considered informational only, and should not be relied or acted upon until a formal attorney-client relationship is established via a written agreement.

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Areas we serve: Acworth, Alpharetta, Ball Ground, Canton, Cartersville, Cumming, Dalton, Holly Springs, Johns Creek, Jasper, Marietta, Nelson, Roswell, Waleska, Woodstock, and more throughout the North-Georgia area.

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