test 2

[grw id=”256″]

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Name
Are you currently employed (Yes or No)
Do 12 or more employees work for the company (if you work for a government entity select yes) (Yes or No)
Are you a member of a protected class based on any of the following – select one or more:
Do you feel you were retaliated against for complaints about one or more of the following (select all that apply):
Have you been paid all wages due timely (Yes or No)
Do you feel you were paid less than others in the same position (yes or no)
Were you sexually harassed (Yes or No)
Do you have documents supporting your claims (text, messages, screenshots, social media posts, etc.) (do not lose this data, it can harm your claim) (Yes or No)
Do not fill in this feild
Ways that you can prove discrimination or retaliation, check all that apply.
How were you harmed
Have you filed a claim for unemployment benefits (yes/no)
Has your employer appealed or "fought" your unemployment claim (yes/no/unsure)
Have you filed a claim with EEOC or any Human Rights Comission (yes/no)
Did you get benifits (yes/no)
Has the job situation caused any repossession, eviction, or loss of services (yes/no)
Have your received medical attention related to anxiety, depression, stress, or other impairment related to your employment situation (yes/no)