Name Phone Number
E-Mail
Does your question involve an employment matter? Yes No
Who is the employer?
How many people are employed there? 1-15 16-25 26-50 51-75 76 or More
How long have you worked there? Years Months
In what position?
Were you terminated? Yes No
If so, when? / / 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 If so, did you get written termination? Yes No
If so, when? / / 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993
If so, did you get written termination? Yes No
Do/Did you have a contract? Yes No
Are you covered by a union? Yes No
Have you filed an internal (union) grievance? Yes No
If so, what stage is it in? (Resolved? Just filed? Etc.?)
Have you filed a charge with the NEOC? Yes No
If so, have you received a right-to-sue letter? Yes No When did you receive it? / / 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993
If so, have you received a right-to-sue letter? Yes No
When did you receive it? / / 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993
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