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Address

180 Grand Ave.
Suite 1380
Oakland, CA 94612

Call : 888-891-8489

Fax : 510-444-9301

Intake Form

Please fill out the following intake form to begin our firm’s intake process. After submission we will reach out if further information is needed prior to us making a decision on whether we can assist at this time.

First Name:(Required)

Last Name:(Required)

Preferred Pronouns:(Required)

Email:(Required)

Phone Number:(Required)

Where did/do you work? (City/State):(Required)

Employer:(Required)

Job Title:(Required)

Date of Hire:(Required)

Are you still employed with the company?(Required)

Yes

If not, what was the date of separation?(Required)

Rate of Pay:(Required)

Federal Employees Only: Have you contacted the EEO, MSPB, or OIG about your issue?

Do you have any upcoming deadlines that you are aware of, related to the action/issue that you are contacting us about?(Required)

Are you or have you ever been represented by an attorney regarding the issue you’re reaching out about? If so, who?(Required)

What harm did you suffer? (examples include: fired, laid off, demoted, reassigned or transferred unfairly, not promoted, reasonable accommodation delayed/denied, harassment, wage/hour violations, etc.)(Required)

When did this happen? Is the issue ongoing? (Timeline or summary of events recommended)(Required)

What reason(s), if any, did your employer give for taking the action(s) that it took? (e.g. layoff, restructuring, performance, "cultural fit," personality conflict, or other reasons)(Required)

Why do you feel your employer is treating you this way? Do you believe your employer is treating you differently because of a protected basis like race/age/national origin etc.? Are there others who are treated differently? If so, on what basis?(Required)

Have you reported this to any state/federal agency? Have you made any written or verbal reports/complaints to your employer about this issue? When and what did you say?(Required)

What resolution or relief are you seeking?(Required)

Do you have an arbitration agreement?(Required)

If there is any other information that you wish to provide for BSL to assess your situation (including offers of severance or settlement), please provide below:

If you have relevant documents related to your claims in your possession, please identify them here. A member of our staff will follow up to request copies if they are needed for our review.

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Call : 888-891-8489

Fax : 510-444-9301

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