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You are here: Home / Contact / Intake Form for Federal Employees

Intake Form for Federal Employees

This intake questionnaire is tailored for employees of the federal government. We will use the information you enter to forward your request to the most relevant practice group. This ensures that we can schedule your consultation as quickly and efficiently as possible

If you are not a federal employee, please use the menu to the right to select the general intake form, or one of the other specialized forms. If you are on a mobile device, the menu will be at the bottom of this page.

Our goal is to be in touch within one business day. So please await an email or phone call by a member of our Intake Department before calling to follow-up on the status of a response to your web form. Please note that it is our policy that when you communicate with our firm by email, you should only communicate using a personal non-work email address. If you do not have a personal email address, please let a member of our Intake staff know. Please be advised that you are not represented by the Gilbert Employment Law, PC, and any deadlines that occur in your matter are your responsibility to meet.

Name *

First

Middle

Last

Title

Your Personal Phone Number *

The best way to reach you by phone

Your Personal Email *

The best way to reach you by email

Address Line 1 *

Street name and number

Address Line 2

Apt., Suite, etc.

City *

City for the above street address

State *

State for the above address

Zipcode *

Postal Zipcode for the above address

Are you a Federal Employee? *

Yes
No

What Agency is your claim against? *

Please specify the Department it is organized under

Current Position or Ending Position with Agency *

Length of Employment with Agency *

Weeks, Months, or Years

In What State was the Work Performed *

If you no longer work for the agency, where are you currently employed?

Are you alleging discrimination? *

Yes
No

If you are alleging discrimination, on what basis?

Sex
Race
National Origin
Color
Marital Status
Disability
Age
Sexual Orientation
Religion
Reprisal
Other

Please check all that apply

If other, please specify

Name the individual(s) you allege discriminated against you

Please provide a brief summary of your matter's background and specific discriminatory claims. *

Have you initiated EEO contact, filed a formal complaint, requested a hearing, or taken other formal action? *

Yes
No

If yes, please specify what action you have taken and the status of that action

Are you facing deadlines related to any of the claims or actions above? *

Yes
No

If yes, what is the date of the deadline?

What is due by the deadline?

Are you facing proposed suspension or termination? *

Yes
No

If yes, the date of the proposal or decision, if issued

Are you Covered by a Union Contract? *

Yes
No

If yes, what is the name and local No. of the union?

Referred By *

If you were not referred to our firm, please enter "none", "NA", or another indicator

If you were referred by one of our attorneys, please select them from the list below

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form. Please be advised that you are not represented by Gilbert Employment Law, P.C. and any deadlines that occur in your matter are your responsibility to meet. *

I have read the above disclaimer

You must indicate you have read the disclaimer

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Put Us on Your Side

Thank you for your interest in Gilbert Employment Law. We look forward to working on your behalf.

In addition to the general intake form, we have a number of specialized forms tailored to common employment law scenarios. Available specialized intake forms are listed below.

Initial Consultation Forms

Contact
Intake Form for Federal Employees
Intake Form for Federal Disability Retirement Applicants

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Silver Spring Location
1100 Wayne Ave, Suite 900
Silver Spring, Maryland 20910

Email
intake@gelawyer.com
Phone
(301) 608 – 0880
Fax
(301) 608 – 0881

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