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Employment Discrimination Intake Form

Please take a moment to fill out this employment discrimination intake form so we can set up a Free Consultation. Once we have a chance to review your submission, we will reach out to set up a time to talk. Your submission will be kept100% confidential.

Full name

Email

Confirm email

Phone

Address

City

State

Name of Employer

Position Held

Type of Discrimination You are Experiencing

Racial Harassment

Sexual Harassment

Retaliation

Sex Discrimination

Racial Discrimination

Disability Discrimination

Pregnancy Discrimination

Sexual Orientation Discrimination

Gender-Identity Discrimination

LGBTQ Discrimination

Religious Discrimination

Age Discrimination

National Origin Discrimination

Other

Prove a Detailed Description of the Mistreatment You Experienced

Date of Last Incident of Mistreament?

How Often Do You Experience Mistreatment

Does Your Employer Know About the Mistreatment?

Yes

No

I'm Not Sure

How Did Your Employer Become Aware of the Mistreatment?

I reported it to a supervisor or manager

A coworker reported it to a supervisor or manager

Supervisor(s) or manager(s) witnessed it

It occurs frequently and openly

Supervisors or managers are the people who are mistreating you

After Your Employer Became Aware of the Mistreatment, did it continue?

Yes

No

I'm Not Sure

Do You Have Witnesses?

Yes

No

I'm Not Sure

Do You Have Evidence?

Yes

No

I'm Not Sure

Please Describe Your Evidence

Thanks for submitting! We will review your submissions and be in touch as soon as possible to set up a free consultation.

Contact Information:

jesse@centrellalaw.com

1-800-715-7255

Savannah Sexual Harassment Lawyer, Savannah Racial Harassment Lawyer, Savannah LGBTQ Discrimination Lawyer, Georgia Sexual Harassment Lawyer, Georgia Racial Harassment Lawyer, Georgia LGBTQ Discrimination Lawyer, Savannah Racial Discrimination Attorney, Savannah Sex Discrimination Attorney | Savannah Civil Rights Attorney | Georgia Civil Rights Attorney, Best Employment Discrimination Lawyer Savannah | Best Employment Discrimination Lawyer Georgia | EEOC Attorney, EEOC Lawyer

Centrella Law Firm - 2023

1305 Barnard St #764 Savannah, GA 31401

Racial Harassment Lawyer | Sexual Harassment Lawyer | Sexual Harassment Attorney | Racial Harassment Attorney | Discrimination Lawyer | Retaliation Lawyer

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