INITIAL CLIENT E-MAIL INTERVIEW FOR ALAN BANOV & ASSOCIATES

NAME:  _______________________________________  DATE: ___________________

PHONE:  _________________________(H)    ______________________Ext.______(W)

CELL PHONE: _________________________ PAGER: __________________________

ADVERSE PARTY (e.g., employer) ___________________________________________
Where do or did you work: D.C.______MD______ OTHER_______  (abbrev. for state)
WHEN DID YOU BEGIN WORK? _________ REPRESENTED BY UNION?__________

COVERED BY A CONTRACT?_______ DID EMPLOYER HAVE HANDBOOK?______

DATE(S) YOUR PROBLEM(S) BEGAN:____________ 

Quick overview of case (please check all that apply).
Wage issues (  )	Discharge (  )  Non-promotion  (  )   Sexual Harassment (  )
Breach of contract  (   )  Severance negotiations (  )  Retaliation  (  ) EEO or EEOC 
case (  ) Court case (  )  Mediation/conciliation (  )  Civil service issues (  )
SUMMARY OF PROBLEMS:
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PRIOR GRIEVANCES OR SUITS OVER PROBLEM:_____________________________

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STATUS OF CASE OR GRIEVANCE: _________________________________________

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DEADLINES OR TIME PRESSURES:__________________________________________

IDENTIFY ANY PRIOR LAWYERS FOR THIS ISSUE _____________________________

How did you find us?____________________________ (e.g., Yellow pages, Lawyers.com)		
If you want Alan Banov & Associates to determine whether you should come in for an initial consultation, please complete this form, typing or printing in the answers, and fax it to Alan Banov & Associates, 301-588-9698, or e-mail it to abanov@banovlaw.com