Confidential Intake Questionnaire (Employment)

If you would like HLG to review your situation, please complete and submit this form.

All information provided is strictly confidential and will not be shared with any third parties.


Basic Information


If yes, on what date(s) and to whom did you complain?


If yes, please explain:

If so, when?

Please list all social media accounts and blogs (if any):


Although the information you provide to us on this form is confidential, completion and/or submission of this form to us
does not create an attorney-client relationship between Hekmat Law Group (the "Firm") and you. No attorney-client relationship
shall exist until you and the Firm make a mutual decision to work together and make a written agreement stating the specific
terms of that attorney-client relationship. While this questionnaire does not create an attorney client relationship, your information
will be confidential and privileged. We will not disclose your information and you may not be compelled to disclose your
communications with us to anyone.

Please note, if you have time deadlines (or statutes of limitations) that are quickly approaching, we cannot guarantee that we will
respond in time for us to assist you in filing a lawsuit or administrative agency complaint. You should take immediate action to avoid
missing any such deadlines. The time within which a charge for discrimination must be filed with the United States Equal Employment Opportunity Commission is 300 days from the claimed unlawful act. The time limit to file a charge of discrimination with the California
Department of Fair Employment and Housing is 365 days from the claim unlawful act. Generally, the time to file other employment
related claims in court is one year from the date of harm, e.g. termination, demotion or transfer.

By submitting your matter below, you acknowledge that you have read and understood the foregoing.