Legal Help Request Form - Employment

First Name

Last Name

Email Address

Home Phone

Work Phone

Street Address

Street Address (cont)

City

State

Zip Code

What area of law, if any, do you believe is involved in your situation?

Do you feel that any of your civil liberties were violated?

Have you retained an attorney or other legal entity to represent you on this legal issue, or requested legal representation from anyone? If so, please include their contact information and indicate whether you give your permission for The Rutherford Institute to contact them.

How did you hear about The Rutherford Institute? Internet Television Radio Newspaper Other

Name of Company

Address of Company

Name of Supervisor

How many employees at the company?

Is the company public or private? Public Company Private Company

What are your position and job duties with the company?

What is your employment record? Can you document your attendance record, etc?

Have you been fired? Suspended? Reprimanded? If so, what are the reasons for this, and are they in writing?

If you have not been fired, suspended, or reprimanded, are there reasons you might be?

Have you been retaliated against because of your religion? If so, please describe who retaliated against you, when this was, and why you believe it was motivated by objections to your religious beliefs.

Are you only seeking advice, and if so, what is the question?

If this situation has to do with your religious beliefs, parental obligations, disability, or similar, did you formally request accommodation? If so, what were the results?

Have you applied for or received unemployment benefits?

Are you a union member? If so, have you contacted your union? If so, what were the results?

If your situation is not fully covered by the above questions, please provide a concise summary of the circumstances that have led you to seek legal assistance. Be as specific and detailed as possible. Include names, ages, dates, places, etc.

How do you believe The Rutherford Institute could help (i.e., giving advice, writing a letter, providing an attorney, etc.)?

Is there any other information that you would like to share or think we might need to know?