If you would like us to contact you:

Please fill out this form with the requested information. We will review your situation and someone from our office will contact you. Depending on the nature of your situation and our office's calendar, we may or may not be able to represent you in your situation.

First Name *

Last Name *

Address *

Email *

Best phone number to reach you *

Best time of day to reach you *

Name of Employer (if not recognizable name, please include a brief description of the sort of work they do) (100 chars left) *

Size of Employer (number of employees) *

What is your job? *

How long have you worked there? *

What is your salary? *

Describe your situation: What happened to you? What made you want to contact an attorney? How long did this go on? (5000 chars left) *

Did you complain to someone? (ie., your supervisor, human resources) Yes No *

To whom did you complain? (200 chars left) *

Was there an investigation? Yes No *

What was the response? (500 chars left) *

Are you still working for this employer? Yes No *

If not, were you fired or laid off or did you quit?

Do you have witnesses or people who will back up your story? Yes No *

Will these people speak to us? Yes No *

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

How has this situation affected your mental and emotional health? (2000 chars left) *

Describe what you would like to happen to resolve your situation. (1000 chars left) *

Thank you for taking time to tell The Gillam Law Firm about your case.

We will review the information and get back with you shortly.

Have a great day!