Other Employment Issues You may find that our other questionnaires do not pertain to your specific employment situation.  Please complete the following information, and after you have completed the general section, you will find an area where you can fill in more details about your specific issues. We generally charge a $300 attorney evaluation fee to meet with a prospective client once we have reviewed a questionnaire and determined that we may be able to provide services.  Even though we have attempted to obtain detailed information through these questionnaires, an in-person evaluation is usually necessary to fully review the case and to determine whether we can provide legal services to a prospective client.  If you wish to ensure the confidentiality of any information you provide to us, please call our office for an in-person consultation with one of our attorneys, instead of completing this internet questionnaire. Name: Address (include city, state, and zip): Telephone:  - Home  - Work  - Cell Email address: Confirm email: Date of birth: Place of birth: Gender: -- Select -- Male Female Race: -- Select -- Caucasian/White African-American/Black Hispanic Asian Other US Citizen: -- Select -- Yes No Employer about whom you are contacting us. How did you hear of our firm? -- Select -- Attorney Yellow Pages Newspaper Article Web Search Other If an attorney referred you, what is the name of the attorney or firm? If another person referred you, what is that person's name?  Do you work for a 1) private company; 2) federal government or 3) state or local government?   Are you a member of a union?    -- Select -- Yes No Description of Legal Problem Please use the space below to describe your situation or matter in more detail so the attorneys can understand your potential case. Scheduling We will contact you by email unless this is not possible.  If you cannot communication via email, please indicate the most convenient method of communication and the best time and day to contact you. PLEASE READ THE FOLLOWING STATEMENTS AND INDICATE YOUR ACCEPTANCE OF THESE TERMS PRIOR TO SUBMITTING THIS FORM. I have prepared the answers to these questions and to the best of my ability. THIS MUST BE ANSWERED OR YOU CANNOT SUBMIT THE FORM! -- Select -- Yes No I understand that the submission of this form does not create any obligation for me or for any attorney at Delegal Law Offices.  I further understand that submission of this form does not create an attorney-client relationship and that the lawyer is not obliged to schedule a consultation with me. I understand and agree that Delegal Law Offices, P.A., will have no duty to keep confidential the information that I am transmitting to the law firm through this questionnaire. THIS MUST BE ANSWERED OR YOU CANNOT SUBMIT THE FORM! -- Select -- Yes No Please enter the following security code General Disclaimer By submitting this application, I understand that I am providing information to Delegal Law Offices, P.A. for its review of my case, but that Delegal Law Offices, P.A. has not provided me with any legal advice and is not serving as my attorney for any purpose unless and until Delegal Law Offices, P.A. enters into a contract to provide me with legal services.  I further understand that I am not a client of the firm and expect no legal services to be performed on my behalf.  By submitting this application, I understand that I am not obligating any specific action to be taken by the Delegal Law Offices, P.A., and I have not been promised that any specific services will be given to me.