Who is your employer?
What is your position?
What is/was your annual income?
Is/Was your employment based on a contract, or were you employed at-will?
At Will
Contract
Upload your employment contract.
Did you have an agreement to resolve disputes through a neutral third party at your job?
No
Yes
What negative action or treatment did you experience?
Termination
Suspension
Demotion
Discipline
Unpaid Leave
Investigation
Other
What harm or losses did you experience?
Economic/Money
Non economic/ Emotional Distress
Please describe the negative action or treatment you are/did experience?
What is the estimated economic loss?
Explain, if needed.
What kind of emotional distress or harm have you experienced?
Have you sought any medical treatment for the emotional distress you've experienced?
Are there any additional details you would like to share?
