Call (866) 920-1292 for a Case Evaluation

If you are a potential client and would like to get your case evaluated, there are two easy ways. You can call the number above, or fill out the case evaluation form below, and we will call you if we believe we can help.

We know the form below is detailed and can take some time to fill out. But please fill it out completely. Please note that submitting the form or calling our office does not create an attorney-client relationship. That type of formal relationship is not formed until a signed fee agreement has been made between the client and the attorney.

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First Name (required) *

Last Name (required) *

Phone Number (required) *

Email Address (required) *

How Did You Find the Bohm Law Group? (required) *Search Engine (i.e. Google)Referral From AttorneyWord of MouthTelevisionPublicationOther

If you were referred to us by an attorney, please put their name here:

Your GenderMaleFemaleOther

What is the name of your employer/company? (required) *

In what state did you physically work for the employer? (required) *

In what state was your employer based?

What was your job title?

Approximately, how long did you work for this employer? (Ex: 4yrs & 2mos)

What was the primary way you were paid? (required) *

• Salary
• Hourly
• Commission
• Other

How much were you paid on an annual basis? (required) *

What was your employment classification? (required) *

• Employee
• Independent Contractor
• Unknown

What was your work schedule like? (required) *

• Full-time
• Part-time
• Per diem
• Seasonal
• Other

What is your employment status now? (required) *TerminatedLaid-offResignedStill EmployedUnknownVoluntary Leave of AbsenceInvoluntary Leave of AbsenceOther

If you answered "Terminated," "Laid Off" or "Resigned," what date did this happen?

If you are currently on a leave of absence, what date did it start?

What kind of adverse actions do you believe were taken against you? *

• Harassment
• Discrimination
• Wrongful Termination
• Retaliation
• Failure to Hire
• Failure to Promote
• Failure to Prevent Harassment/Discrimination
• Other

When was the last time one of these adverse actions was taken against you? (date)

Did you ever make a complaint (verbally or writing) about one of these adverse actions?

If yes, when did you make the complaint?

If yes, who did you make the complaint to?

Briefly, tell us about your case: *

Where do you reside now? (city & state)

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