Employment Law Intake Form Template
A free employment law intake form for lawyers who represent workers. Screen firing, discrimination and wage claims, and see which cases to call first.
Customize the pages and design to fit your needs.
About this template
Ask each worker what happened, when, the employer's name and size, and whether they have been offered severance, with uploads for letters and pay stubs. Lead mode marks recent claims against larger employers as hot leads.
Common uses
- Employment law firms
- Wrongful termination and wage claims
- Severance review requests
Key features
- Claim type, timing and employer size
- Document uploads
- Hot leads for recent claims
What this template asks
What's your full name?
Short Text
What's your email address?
Email
What's your phone number?
Phone
Who is your employer?
Short Text
What happened at work?
Multiple Choice · I was fired or laid off, Discrimination, Harassment, Unpaid wages or overtime, Retaliation for speaking up, Medical or family leave denied, Something else
Do you still work there?
Single Choice · Yes, No, I was let go, No, I quit
When did it happen?
Single Choice · Within the last 6 months, 6 to 12 months ago, 1 to 2 years ago, More than 2 years ago
Roughly how many people work for the employer?
Single Choice · Fewer than 15, 15 to 100, More than 100, Not sure
Have you been offered a severance agreement?
Yes / No
Have you filed a complaint with a government agency?
Yes / No
Do you already have a lawyer for this?
Yes / No
Briefly describe what happened
Long Text
Upload any letters, emails or pay stubs
File · Optional
When is the best time to call you?
Single Choice · Morning, Afternoon, Evening
How to use this template
Copy it
Select Use template and a copy opens in your workspace as an unpublished draft.
Make it yours
Edit any question or answer, choose a theme, and add your logo.
Share it
Publish, then send the link, show a QR code, or embed the form on your site. Responses arrive in Submissions.
Frequently asked questions
Who is this employment law intake for?
Lawyers who represent workers in firing, discrimination, harassment, retaliation, leave and unpaid wage claims.
How does lead mode screen employment cases?
Recent claims against employers with 15 or more people, and anyone holding a severance offer, come through as hot leads. Anyone who already has a lawyer is marked not a fit.
Can workers send documents with the form?
Yes. They can upload termination letters, emails, pay stubs and severance offers, so you review the papers before the first call.