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The Kirby G. Smith Law Firm

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MORE INFORMATION

Thank you very much for reaching out to The Kirby G. Smith Law Firm. Our Intake Specialists will need more information about your case in order to better assist you. We will need your name, phone number, and email address so we can keep your information linked to your prior form. Please complete the following form below and we will be back in touch with you.

First name*

Last name*

Email*

Phone*

ZIP Code*

Why do you think the issues at work are happening? Check all that apply.*

Discrimination

Retaliation for Reporting Discrimination

Whistleblower Retaliation

If you chose discrimination above, what type of discrimination are you experiencing? Check all that apply.

Disability

Race/Color

Gender

Age

National Origin

Religion

Sexual Orientation

Has your pay been affected? Check all that apply.

Termination

Suspension

Demotion/Pay Decrease

Hours Cut

Lost Bonus

Lost Commission

Lost Stock Options

Has anything happened that did not affect your pay? E.g., harassment, hostile work environment, etc. If so, describe.

When did these things happen to you?*

Why is the employer claiming they did these things to you? If they did not give you a reason, note that here.*

If any of the reasons the employer gave you are false, explain how you know they are false.

If any of the reasons the employer gave you are true, do you see a difference in treatment between yourself and other employees or a difference between company policy and how you were treated? Explain the difference you see.

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