Employment Law Case Evaluation Form

Important Notice: Submitting this form does not create an attorney-client relationship. The information you provide is for evaluation purposes only. We may decline representation for any reason. Do not include sensitive medical details beyond what is necessary. All communications remain subject to applicable ethics rules regarding confidentiality of prospective clients.

1 Your Contact Information

Full Legal Name Preferred Name (if different)

Email Address

Mobile Phone

Preferred Method of Contact

City / State

Zip Code

2 Your Employment

Employer / Company Name Employer Location (City, State) Approximate Number of Employees (company-wide)

Title VII and ADA generally require 15+ employees; ADEA requires 20+.

Your Job Title / Position

Approximate Date of Hire

Last Day Worked or Termination Date

Are you still employed by this employer? Reason the employer gave for separation (if any) Pay Type & Approximate Compensation

4 Key Facts & Timeline

Brief summary of what happened (most important facts only)

Tip: Judges and intake attorneys care most about specific dates, comparators, and what was said or done.

Date of the most recent discriminatory, retaliatory, or adverse action

Critical for statute-of-limitations analysis (EEOC 300-day window in Texas, 90-day right-to-sue, etc.).

Did you complain internally (to HR, a manager, ethics hotline, or in writing)? Approximate date of any internal complaint Names / titles of key decision-makers, harassers, or witnesses

5 EEOC / TWC Filings (Very Important)

Many federal claims require a timely charge. Missing these deadlines can permanently bar a lawsuit.

Have you filed a Charge of Discrimination with the EEOC?

EEOC Charge Number (if known)

Date Charge was filed

Have you received a Right-to-Sue Notice from the EEOC? Date you received (or the notice was issued)

You generally have only 90 days from receipt to file a federal lawsuit.

Have you also filed with the Texas Workforce Commission Civil Rights Division?

6 Evidence & How You Found Us

What documents, emails, texts, recordings, performance reviews, or witnesses do you have? Have you already spoken with any other attorneys about this matter? How did you hear about our firm?

I understand that submitting this form does not create an attorney-client relationship, that the firm may decline the matter, and that I am authorizing the firm to contact me by phone, text, or email regarding this inquiry. I confirm the information is accurate to the best of my knowledge.

1 Your Contact Information

2 Your Employment

3 Nature of Your Potential Claim

4 Key Facts & Timeline

5 EEOC / TWC Filings (Very Important)

6 Evidence & How You Found Us