1. Employment Status

Which best describes your current situation? *

I was fired, laid off, forced to quit, or I’m not working for a reason I don’t fully understand

I’m still working and experienced sexual harassment

I'm still working, did NOT experience sexual harassment, and I am planning to leave regardless of any legal outcome

I'm still working, did NOT experience sexual harassment, and I am not planning to leave

2. Mistreatment Type

Which of the following apply to your situation? *

Discrimination (e.g., Treated unfairly because of race, sex, pregnancy, disability, sexual orientation, age, religion, etc.)

Harassment (e.g., subjected to a hostile work environment because of your sex, race, religion, sexual orientation, etc.)

Retaliation (e.g., Fired or disciplined for reporting something you thought was unlawful, or for requesting an accommodation, or for requesting leave due to your disability or to care for a loved one, etc.)

None of the above

3. Government Employee Status

Are you a government employee? *

Yes

4. Location of your employment

Were you employed within the state of California or working remotely from a location in California during the underlying events?

Yes

5. Timing of Mistreatment

Did the mistreatment happen within the last 3 years? *

Yes

6. Legal Action Status

Have you already hired a lawyer or filed in court? *

Yes

7. Severance

Which of the following best describes your severance situation? *

I signed a severance agreement

I didn't sign a severance agreement

8. Readiness to Move Forward

If we believe we may be able to help you, would you be ready to move forward with Smith Law? *

Yes

First Name *

Last Name *

Email *

Phone No. *

Brief description of your situation

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