Jump to Navigation
17 Academy Street, Suite 1010 Newark, NJ 07102 | Call: 973-242-3636 | Email: intake@thedwyerlawfirm.com

Questionaire

Please complete this questionaire as thoroughly as possible.

If Something does not apply, just write in "N/A." There may also be instances where you do not know something we ask about on the form. If that is the case, just tell us you do not know.

By providing this questionaire, we are NOT agreeing to represent you or to be your attorneys. This is a preliminary inquiry to enable us to make a solid evaluation of your facts and a determination of whether we will represent you in the future.

Please complete this questionaire as thoroughly as possible.

If Something does not apply, just write in "N/A." There may also be instances where you do not know something we ask about on the form. If that is the case, just tell us you do not know.

By providing this questionaire, we are NOT agreeing to represent you or to be your attorneys. This is a preliminary inquiry to enable us to make a solid evaluation of your facts and a determination of whether we will represent you in the future.

Please complete this questionaire as thoroughly as possible.

If Something does not apply, just write in "N/A." There may also be instances where you do not know something we ask about on the form. If that is the case, just tell us you do not know.

By providing this questionaire, we are NOT agreeing to represent you or to be your attorneys. This is a preliminary inquiry to enable us to make a solid evaluation of your facts and a determination of whether we will represent you in the future.

Please complete this questionaire as thoroughly as possible.

If Something does not apply, just write in "N/A." There may also be instances where you do not know something we ask about on the form. If that is the case, just tell us you do not know.

By providing this questionaire, we are NOT agreeing to represent you or to be your attorneys. This is a preliminary inquiry to enable us to make a solid evaluation of your facts and a determination of whether we will represent you in the future.

*Name:

*Home Address:

*City:

*State:

*Zip:

*E-mail address:

*Telephone:

Cellular:

Date of Birth:

Name of Employer:

Employer's Address:

How Long With This Employer?

Job Title:

Salary:

Did you have an employment contract?
Yes  No 

Were you a member of a union?
Yes  No 

Does your claim arise out of any of the following (Check all that apply):






Please give the date when the most recent adverse action was taken against you by the employer:

Do you claim that the treatment you have suffered on the job is related to any of the following (Check all that apply):












    


Even if it is not actually true, please describe the reason(s) the employer would probably give for the actions it took against you:

Even if you cannot prove that it's true, please describe what you believe are the real reasons for the actions the employer took against you:

If you already have any claims pending related to this employer (for example, in court, workers compensation, unemployment compensation, with the EEOC or DCR), please describe those claims and their current status:

How did you learn about our office?


"Lawyers Working For Working People"

The Dwyer Law Firm, L.L.C. serves clients throughout the New Jersey and New York metropolitan area including the cities of Newark, Morristown, Jersey City, Hackensack, Elizabeth, Trenton, Atlantic City, Camden, New Brunswick, Freehold, Toms River, Paterson, Woodbridge, Paramus, East Orange, Plainfield, Princeton, Edison, Clifton, Passaic, Union City, Bayonne, Irvington, Union, Parsippany, Bloomfield, West Orange, Montclair and the counties of Atlantic, Bergen, Camden, Essex, Hudson, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic and Union.