Whisleblower Form to Report Unlawful Action
Disclaimer: Completing this form does not establish an attorney-client relationship. We become your lawyer only after we have agreed in writing to represent you as a client. Once you have signed and submitted our retainer agreement and paid the requisite initial attorney’s fee, we will send you a copy of the fully-executed retainer agreement. Until then, no attorney-client relationship has been established.
[raw][contact-form subject=”Weston Lawyers Whisleblower Form to Report Unlawful Action” to=”[email protected]”]
[contact-field label=”Brief nature of Unlawful Action” type=”text” required=”true” /]
[contact-field label=”Name” type=”name” required=”true” /]
[contact-field label=”Phone Number” type=”text” required=”true” /]
[contact-field label=”Alternative Number” type=”text” required=”true” /]
[contact-field label=”Best time to call you?” type=”select” options=”Morning,Afternoon,Evening” /]
[contact-field label=”Email Address” type=”email” required=”true” /]
[contact-field label=”Best way to contact you?” type=”select” required=”true” options=”Email,Phone” /]
[contact-field label=”Address” type=”textarea” required=”true” /]
[contact-field label=”City” type=”text” required=”true” /]
[contact-field label=”State” type=”text” required=”true” /]
[contact-field label=”Zip” type=”text” required=”true” /]
[contact-field label=”Defendant” type=”text” /]
[contact-field label=”Did the unlawful action take place in the workplace” type=”radio” options=”Yes,No” /]
[contact-field label=”If yes. provide details of unlawful action in the workplace:” type=”textarea” /]
[contact-field label=”Is the unlawful action against the government?” type=”radio” options=”Yes,No” /]
[contact-field label=”If yes. provide details of unlawful action against the government:” type=”textarea” /]
[contact-field label=”Did you disclose the unlawful action to your employer, government or anyone else?” type=”radio” options=”Yes,No” /]
[contact-field label=”If Yes, whom did you disclose information to and when?” type=”textarea” /]
[contact-field label=”Describe your goals in contacting in reporting unlawful action:” type=”textarea” /]
[contact-field label=”How did you find us? ” type=”text” /]
[contact-field label=”I have read and understand the disclaimer ” type=”checkbox” required=”true” /]
[/contact-form][/raw]
