Employees Case Evaluation Form | Florida Employment & Labor Law Firm Donna M. Ballman Fort Lauderdale, Miami, West Palm Beach, Naples

Employee Contact Form

*Name:

*Address:

*City:

*State:

*Zip:

*E-mail address:

*Home Phone:

Business Phone:

Cellular or Pager:

Facsimile:

Please provide the name and address of the employer involved:

Are you a current ______ of this employer?
employeeformer employeejob applicantprospective employee

Are you presently employed?
YesNo

If yes, please provide your job title and employer's name and address.

Can you be contacted at work?
YesNo

Describe your situation, including any relevant dates:

Are you a union member?
YesNo

If yes, provide the name, address, and local number:

Have you made a complaint about your situation to any governmental agency?
YesNo

If yes, provide the name of the agency, the date you made your complaint, and the final result, if any, of your complaint:

Are any other people involved?
YesNo

If yes, provide names, addresses (if known), and their relationship to you, if any:

Do you have any documents that could help explain your situation?
YesNo

If yes, list those documents and their dates:

Are there other documents that you do not have access to that could be of assistance?
YesNo

If yes, list those documents and their dates and locations (if known):

Describe how this situation has impacted you:
Describe what you would like to happen to resolve your issue (your preferred outcome):
Have other attorneys worked on this matter? YesNo
If yes, provide names, addresses, and a brief description of their involvement:
Special concerns:
Where did you hear about this website?

NOTE: The use of the Internet for communications with the firm will not establish an attorney-client relationship and messages containing confidential or time-sensitive information should not be sent.

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Donna M. Ballman, P.A.
5001 S. University Drive, Suite G
Fort Lauderdale, FL 33328
Telephone: 954-680-6300
E-mail

Providing skilled employment and labor representation to employees in south Florida and the Florida Keys, including the counties of Broward, Palm Beach, and Miami-Dade and the cities of Fort Lauderdale, Miami, West Palm Beach, Naples, and Stuart.

The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for individual advice regarding your own situation.

Our employment law attorneys at the law offices of Donna M. Ballman, P.A. represent employees throughout south Florida and the Florida Keys, including the cities of: Fort Lauderdale (Ft. Lauderdale), Miami, West Palm Beach, Naples, Ft. Meyers, Tampa, St. Petersburg, Gainesville, Jacksonville, Stuart, Jupiter, Boca Raton, and Hollywood. Our employment lawyers also represent employees in the following counties: Broward County, Palm Beach County, and Miami-Dade County. Whether you need a south Florida wrongful termination attorney or a Fort Lauderdale retaliatory discharge lawyer, we can help.

Copyright © 2010 by Donna M. Ballman, P.A. Employment Law Attorney. All rights reserved. You may reproduce materials available at this site for your own personal use and for non-commercial distribution. All copies must include this copyright statement.