ManualSubmission Get Help Now Home Manual Submission Name First Last Phone*Email* Address Street Address County in Which You Reside What state are/did you work in? CT MA Other Please Enter the State(s) You Worked In Name of Employer Job Title Length of Employment Were you terminated from you employment?* Yes No Did you receive final paycheck on termination day.* Yes No When did you receive your final paycheck?* When were your terminated? What was the reason your employer gave for your termination? Not given Not working out Personal differences Other Please describe the reason your employer gave for your termination. What do you think was the real reason for your termination? Personal differences or personality clash Retaliation Race/Nationality discrimination Age discrimination Gender discrimination Pregnancy discrimination Religious discrimination Other Please describe what you think the real reason was for your termination. Are you in a union? Yes No Do you work more than 40 hours a week? Yes No Were you paid hourly or salary? Hourly Salary What was your rate of pay? Reason for contacting Hayber, McKenna, & Dinsmore Unemployment Hearing Learn my Rights Sue the Employer Collect Unpaid Wages Review Severance Package Other Briefly describe your case.*How did you hear about Hayber, McKenna, & Dinsmore Internet Attorney Referral Other Who is the referring attorney? Where did you hear about us? Δ
