Facebook-f
Instagram
Linkedin-in
Language:
ES
EN
ES
EN
(310) 929-2190
Inquiries@HersheyLaw.com
Home
Team
Brennan Hershey
Johnny Rundell
Practice Areas
Wage & Hour
Whistleblower
Severance Agreement Review and Negotiation
Discrimination
Wrongful Termination
California Layoff Laws
Retaliation
Harassment
Severance Negotiation
Service Areas
Los Angeles
Ventura
Burbank
Long Beach
Orange County
Lancaster
Beverly Hills
Pasadena
San Diego
Glendale
Santa Monica
San Bernardino
Results
Blog
Contact Us
Contact Us
If you require legal expertise in any area of California employment law, please reach out to request a free consultation.
"
*
" indicates required fields
First Name
*
Last Name
*
Email
*
Phone Number
*
Where Are You Located?
*
Select State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Hershey Law only provides services to California employees.
Employment Information
Company Name
*
Company Address
*
Job Title
*
Daily Job Duties:
*
Employment Status:
Select…
Current Employee
Former Employee
Job Applicant
Contractor
Unpaid Intern
Volunteer
Other
If Other, Please Explain:
Hired On:
MM slash DD slash YYYY
Terminated On:
MM slash DD slash YYYY
Do you have an existing severance agreement or offer?
*
Select…
Yes
No
This field is hidden when viewing the form
Practice Area
Yearly Salary or Hourly Rate
If hourly, please also tell us how many hours per week you worked
Did your employment end as a result of a termination or layoffs?
Termination
Layoff
Were others terminated/laid off as well? If so, how many people?
Severance Agreement Offer
Desired Outcome
Do you believe that your severance agreement/offer was given to you as a result of anything other than the reason claimed by your employer?
(e.g. after you reported actions or activities you believed to be illegal, after disclosing a disability/condition, complaining about workplace safety, etc.?)
Incident Details
Briefly describe the incident or issue:
When did this occur?
MM slash DD slash YYYY
Have you filed any complaints with your employer or government agencies?
Select…
Yes
No
Have you suffered any financial losses?
Select…
Yes
No
If yes, estimated amount:
Please review the following and select all that apply:
Wage and Hour Violations
NOTE: This includes not receiving proper meal/rest breaks or unpaid overtime work.
Wage and Hour Violations (including failure to provide meal and rest breaks, or unpaid overtime)
Harassment
NOTE: Unwelcome conduct based on protected characteristics that creates a hostile work environment. Select the specific type(s) of harassment you experienced (sexual, racial, etc.).
Sexual Harassment
Harassment on the Basis of:
Harassment Basis
Race/Color
Age (40 and over)
Marital Status
Ancestry, national origin
Disability (Mental/Physical)
Genetic Information
Religion/Creed
Sexual Orientation
Medical Condition
Military/Veteran Status
Gender Identity/Gender Expression
Sex/Gender (including pregnancy, childbirth, breastfeeding or related medical conditions)
Discrimination
NOTE: Unfair treatment based on protected characteristics. Protected characteristics include:
Race/Color: Unfair treatment based on your race or skin color
Disability: Discrimination based on physical or mental conditions
Sex/Gender: Including discrimination related to pregnancy, childbirth, or breastfeeding
Age (40+): Discrimination against employees 40 years or older
And others listed here
Discrimination on the Basis of:
Discrimination Basis
Race/Color
Age (40 and over)
Marital Status
Ancestry, national origin
Disability (Mental/Physical)
Genetic Information
Religion/Creed
Sexual Orientation
Medical Condition
Military/Veteran Status
Gender Identity/Gender Expression
Sex/Gender (including pregnancy, childbirth, breastfeeding or related medical conditions)
Other Issues
NOTE: Other issues include the following:
Retaliation: Negative actions taken against you for reporting violations
Wrongful Termination: Being fired for illegal reasons
Retaliation
Wrongful Termination
Other Issues (Please Describe):
Additional Information
How did you hear about us?
*
Any additional comments?
Comments
This field is for validation purposes and should be left unchanged.
Home
Team
Brennan Hershey
Johnny Rundell
Practice Areas
Wage & Hour
Discrimination
Harassment
Whistleblower
Wrongful Termination
Retaliation
Severance Agreement Review and Negotiation
California Layoff Laws
Severance Negotiation
Service Areas
Beverly Hills
Burbank
Glendale
Lancaster
Long Beach
Los Angeles
Orange County
Pasadena
San Bernardino
San Diego
Santa Monica
Ventura
Results
Blog
Hershey Law only provides services to California employees.
