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Client Intake Questionnaire (Employment - Defense) - Free Editor

Client Intake Questionnaire (Employment - Defense)

1. Company Information

Legal company name:
DBA/Trade name (if any):
Parent or affiliate entities (if applicable):
State of formation:
Principal business address:
Industry and business description:
FEIN:
Total employees (company-wide):
Employees at relevant location:
Unionized workforce? ☐ Yes ☐ No

2. Primary Contact and Authorized Decision-Maker

Name and title:
Email/phone:
In-house counsel (if any):
Authorized decision-maker for settlement:

3. Claimant/Employee Information

Claimant name:
Job title/department:
Supervisor/manager:
Employment start date:
Employment end date (if terminated):
Exempt or non-exempt classification:
Pay rate and schedule:

4. Nature of Allegations

Select all that apply:
☐ Discrimination (race/sex/age/disability/religion/national origin)
☐ Harassment / hostile work environment
☐ Retaliation
☐ Wage and hour violations
☐ Leave/ADA accommodation issues
☐ Whistleblower claims
☐ Wrongful termination
☐ Contract/severance dispute
☐ Trade secrets / non-compete / non-solicit
☐ Other: ________________________

5. Employment History and Performance

Position description and essential functions:
Performance reviews (dates and ratings):
Disciplinary actions and warnings:
Attendance or conduct issues:
Prior complaints by claimant (who/when/how):

6. Policies, Agreements, and Training

☐ Employee handbook and acknowledgments
☐ Anti-harassment policy and training records
☐ Timekeeping and meal/rest break policies
☐ Leave policy (FMLA/ADA/state)
☐ Arbitration agreement
☐ Confidentiality / non-compete / non-solicitation agreement
- Dates of policies and acknowledgments:

7. Key Events and Timeline

Summary of key events and dates:
Decision-makers involved:
Any comparators or similarly situated employees:

8. Internal Investigation and Remedial Steps

Was an internal complaint made? ☐ Yes ☐ No
Investigation conducted by (name/title):
Witnesses interviewed:
Findings and conclusions:
Remedial actions taken:

9. Administrative Proceedings

EEOC or state agency charge filed? ☐ Yes ☐ No
Date filed and charge number:
Response deadline:
Right-to-sue letter received? ☐ Yes ☐ No

10. Litigation or Arbitration Status

Demand letter received? ☐ Yes ☐ No
Lawsuit filed? ☐ Yes ☐ No Court/Case No.:
Arbitration agreement invoked? ☐ Yes ☐ No
Opposing counsel contact info:

11. Documents to Provide

☐ Personnel file and job description
☐ Offer letter / employment agreement
☐ Employee handbook and policies
☐ Training records and acknowledgments
☐ Performance reviews and discipline records
☐ Time and pay records
☐ Emails, texts, and relevant communications
☐ Investigation file and notes
☐ Severance or settlement agreements
☐ Insurance policies (EPLI)
☐ Other documents: ________________________

12. Insurance and Indemnity

EPLI carrier and policy number:
Notice provided to carrier? ☐ Yes ☐ No Date:
Third-party indemnity agreements (staffing/vendor):

13. Objectives, Budget, and Constraints

Business objectives (defense, settlement, policy change):
Budget expectations:
Sensitive business or reputational concerns:

14. Litigation Hold and Preservation

Litigation hold issued? ☐ Yes ☐ No Date:
Custodians notified and systems preserved:

15. Acknowledgment

I certify that the information provided is accurate to the best of my knowledge and understand that submission does not create an attorney-client relationship until a written engagement agreement is signed.

Client/Company representative signature: ____________________________ Date: __________

Intake received by (staff): ____________________ Date: __________

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