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Employment Law Intake Questionnaire

Please provide detailed information about your employment matter so we can evaluate your situation and provide effective counsel under Louisiana, Mississippi, and federal law. Many employment claims are governed by strict filing deadlines, so prompt and complete answers are important.

985-612-7220 | stephen@aertkerlegal.com | www.aertkerlegal.com | 229 N. Vermont St., Covington, LA 70433
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PLEASE READ FIRST. Submitting this questionnaire does not create an attorney-client relationship and does not by itself make you a client or prospective client of the firm. No representation begins until the firm has checked for conflicts of interest and you and the firm have signed a written engagement agreement. Please do not include confidential strategy or other highly sensitive details until the firm has confirmed it can represent you. Please be sure to name your employer (and any individual supervisors or managers involved) so the firm can check for conflicts of interest. Information you submit is handled confidentially consistent with Louisiana Rule of Professional Conduct 1.18.
1
Contact Information
Please provide your contact details so we can reach you regarding your matter.
Helps us evaluate age-related (40+) claims.
Tell us if there are times or methods we should avoid.
2
Employment & Claim Overview
Tell us about your job and the problem you are facing. Select the categories that best describe your matter — this will open the relevant follow-up sections below.
The company or person you worked for. We need this to check for conflicts.
Name and title of the person(s) involved, if known.
If still employed, leave blank.
Employer size can affect which laws apply.
In your own words, what is the problem and what would you like to accomplish?
3
Termination / Loss of Job
Tell us how your employment ended. Louisiana and Mississippi are both at-will states, so it helps us to understand exactly what was said and why.
What reason were you told, verbally or in writing?
4
Discrimination & Harassment
Discrimination and harassment claims usually require a filing with the EEOC (and sometimes a state agency) within a strict deadline. Please answer as completely as you can.
Describe the conduct, who did it, and roughly when it occurred.
Important for the filing deadline.
5
Retaliation & Whistleblower
Retaliation means being punished for doing something the law protects. Tell us what you did and how the employer responded.
e.g., fired, demoted, cut hours, disciplined, harassed.
The timing between the two often matters.
6
Wages, Hours & Final Pay
Tell us about the money you believe you are owed. Louisiana has specific penalties for unpaid final wages (La. R.S. 23:631–632).
7
Non-Compete / Restrictive Covenants
Non-compete agreements are heavily regulated in Louisiana (La. R.S. 23:921) and Mississippi. The exact wording matters, so please attach the agreement if you can (Section 12).
8
Leave, FMLA & Accommodation
Tell us about leave or accommodation you requested for your own or a family member's medical condition, pregnancy, or disability.
Was it denied, ignored, or did something happen after you asked?
9
Severance / Separation Agreement
If you have been offered a severance or separation agreement, these often have a short deadline to sign. Please attach the agreement in Section 12 if you have it.
Tell us right away if this is close.
10
Unemployment Benefits Appeal
Unemployment appeals have very short deadlines (often about 15 days from the determination date). Please give us the dates right away.
Critical — this deadline is strict.
11
Prior Filings & Deadlines
Employment claims are governed by strict deadlines. Even if you are not sure, tell us what you know so we can protect your rights.
A right-to-sue letter usually starts a 90-day clock to file suit.
Hearing dates, deadlines to sign or respond, etc.
12
Additional Information & Submission
Please share any additional documents and information that will help us understand your matter.
List any documents available for our review. Copies can be provided separately.

Attach up to three documents relevant to your matter — for example an offer letter, employee handbook, employment or non-compete agreement, termination or severance letter, pay stubs, or EEOC paperwork. PDF, Word, or image. You may bring or email additional documents to your consultation.

Up to ~7 MB total across all files. For larger or highly sensitive files, please email them separately or bring them to your appointment.

For questions about this form or to reach our office, contact 985-612-7220 or stephen@aertkerlegal.com.

This questionnaire is confidential. Communications from prospective clients are protected under Louisiana Rule of Professional Conduct 1.18. Stephen C. Aertker, Jr. is licensed in Louisiana and Mississippi.