Employment Questionnaire

Using the form below, please give us some of the basic information about your situation. Please take your time to answer the following questions as accurately and completely as possible. Please answer all questions that may apply to your situation. If a question is inapplicable, simply write N/A. At the end of the questionnaire there is additional room to supplement your answers or to add any additional information you think is relevant to your potential claim.

Please be advised that submitting this questionnaire does not create or constitute an attorney-client relationship between you and Kerry Murphy Law LLC. By clicking “submit,” you agree that any subsequent communication between us is not intended to convey or constitute legal advice, or to provide a substitute for obtaining legal advice from a qualified attorney, and will not constitute an attorney-client relationship unless we have entered into a written agreement to represent you.

"*" indicates required fields

Your Information

Name*

First Last

Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Your Age*

Your Race/Ethnicity*

When is the best time for us to call you?*

How did you hear about our firm?*

If someone referred you to us, please tell us their name.

What are the main issues you would like to discuss with us? Select all that apply.*

Employment discrimination

Sexual harassment

Employee leave

Retaliation

Whistleblower issues

Discriminatory compensation

Wrongful termination

Employment contract review or negotiation

Severance or separation agreement

Non-competition agreement

Other

What is the name of your employer (or former employer)?*

Are you currently working for this employer?*

Yes

Were you a union member when the events at issue occurred?*

Yes

What is the employer's address? If there is more than one location, please provide the information for the location where you worked.*

Approximately how many other employees worked for the employer at your location?*

Approximately how many other employees worked for the employer company or organization-wide?*

What is your current or most recent job title or position with the employer?*

Your salary / compensation*

Date your employment began*

Date your employment ended (if applicable)*

Briefly describe the discrimination, harassment, and/or other mistreatment that you experienced or describe the issue that you are seeking assistance with.*

What are your main reasons for seeking legal advice or representation?*

Are there any specific outcomes that you hope to achieve by pursuing your claims? If so, briefly describe what you have in mind.*

Please provide a date by date timeline of your situation, including the dates of any major incidents or events (or upload in Word or PDF format). All documents must be uploaded in Word or PDF format.

Detailed, date by date timeline / summary of events

Max. file size: 64 MB.

List of relevant individuals (first and last name, title/position, and significance)

Max. file size: 64 MB.

Employee handbook/manual

Max. file size: 64 MB.

Relevant correspondence, emails, texts, and other communications (if you have text messages, please provide them in PDF format using an app like iMazing (for iPhones) or the Text Collector app (for Androids)

Max. file size: 64 MB.

Any written complaints that you made during your employment

Max. file size: 64 MB.

Documents submitted to or received from the EEOC

Max. file size: 64 MB.

Other documents that might be helpful to understanding your situation.

Drop files here or

Max. file size: 64 MB, Max. files: 10.

Please provide a brief description of any documents uploaded above, including their importance to your case.*

Are you aware of any upcoming deadlines? If so, please list them here.*

Have you been involved in any lawsuits or other legal proceedings related to the issues you want to discuss with us?*

Yes

If you answered yes to the question above, please describe the related proceedings, including the court, parties, filing date, and status of each.

Have you contacted the EEOC (Equal Employment Opportunity Commission) regarding your case?*

Yes

If you have received a Notice of Right to Sue or Dismissal and Notice of Rights from the EEOC, please list the date it was issued.*

Have you contacted any other government agencies about your case? If so, please describe each.

Have you talked to any other attorneys about your potential claims?*

Yes

Is there any other information that we should know about your situation prior to your consultation?

Disclaimer*

Please be advised that completing this form and scheduling an initial consultation does not create an attorney-client relationship between you and Kerry Murphy Law LLC ("the Firm"). We do not and will not represent you in any legal matter, including those set forth herein and/or discussed during your initial consultation, unless and until you and the Firm have executed a written engagement letter or fee agreement setting forth the terms of representation and our agreed-upon fees. The Firm reserves the right to decline representation of any person prior to or following a consultation. By checking the box below and submitting this intake form, you acknowledge and agree that (1) there is no attorney-client relationship between you adn the Firm; (2) the Firm has made no representation or guarantee as to the outcome of your consultation, and (3) the Firm will not represent you unless we have both signed a written engagement letter or fee agreement.

I have read and agree to the terms above

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KERRY MURPHY LAW LLC
201 St. Charles Avenue, Suite 2500
NEW ORLEANS, LA 70170

PHONE: (504) 603-1500
FAX: (504) 603-1503
INFO@KERRYMURPHYLAW.COM