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Potential Client Intake Form

 

Employment Information

Did you submit an accommodation request?
What is the status of your request?

Exemption Request

Please complete the following in as much detail as possible:

1.

2.

3.

4.

5.

Have you filed a claim with any goverment agency (OHR, EEOC, etc.)

6.

Do you have documentation for all statements provided above?

Please have all documentation prepared to submit to our office upon request

Thank you for your interest in our firm. Our staff will contact you as soon as your information has been reviewed.