Sexual Harassment Contact Form


Sexual Harassment Contact Form

Name

Email Address

Phone Number

Business Phone

Cellular or Pager

Address

City

State

Zip

Can you be contacted at work?
Yes  No 

Does this situation involve an employer?
Yes  No 

If so, please provide the name and address of the employer involved:

Are you a current _____ of this employer?
employee  former employee  job applicant  prospective employee 

If this situation does not involve an employer, please provide the name and address of the party involved, and that party's relationship to you:

Describe your situation, including any relevant dates:

Have you made a complaint about your situation to any governmental agency?
Yes  No 

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

Please provide the names and addresses (if known) of the other people involved, and their relationship to you, if any:

Do you have any documents that could help explain your situation?
Yes  No 

If yes, list those documents and their dates:

Are there other documents that you do not have access to that could be of assistance?
Yes  No 

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?
Yes  No 

If yes, provide names, addresses, and a brief description of their involvement:

Special concerns:

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  • $30.7 Million

    Sexual Harassment
  • $20 Million

    Age Discrimination
  • $3.6 Million

    Racial Discrimination
  • $1.68 Million

    Gender Discrimination
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Do you believe you are a victim of an employee rights violation or other injustice? Contact our firm for a case evaluation. Ask about our experience with confidential pre-litigation settlements and our previous courtroom successes.
We can be reached in Los Angeles at 323-302-4774 and New York at 212-202-2966.
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Allred, Maroko & Goldberg

Los Angeles
6300 Wilshire Boulevard, Suite 1500
Los Angeles, CA 90048

Phone: 323-302-4774
Fax: 323-653-1660
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305 Broadway, Suite 607
New York, NY 10007

Phone: 212-202-2966
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