Employment Case Questionnaire

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CONTACT INFORMATION

POTENTIAL DEFENDANT EMPLOYER:

Hire Date*

Date of Termination (if applicable)

Wrongful Termination
Failure to Promote
Failure to Accommodate
Discrimination based on Race
Demotion
Discrimination based on Age
Discimination based on Religion
Denial of Equal Pay
Discrimination based on Disability
Sexual Harassment
Discrimination based on Sexual Orientation
Other
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