# 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.

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.

Canonical: https://reuily.com/templates/employment-law-intake-form
Use this template: https://reuily.com/form/from-template/employment-law-intake-form
Collections: Marketing & Sales, Requests & Intake, Professional Services, Legal
Last updated: 2026-10-24

## Questions

- Question 1: What's your full name? (Short Text, required)
- Question 2: What's your email address? (Email, required)
- Question 3: What's your phone number? (Phone, required)
- Question 4: Who is your employer? (Short Text, required)
- Question 5: What happened at work? (Multiple Choice, required). Options: I was fired or laid off; Discrimination; Harassment; Unpaid wages or overtime; Retaliation for speaking up; Medical or family leave denied; Something else
- Question 6: Do you still work there? (Single Choice, required). Options: Yes; No, I was let go; No, I quit
- Question 7: When did it happen? (Single Choice, required). Options: Within the last 6 months; 6 to 12 months ago; 1 to 2 years ago; More than 2 years ago
- Question 8: Roughly how many people work for the employer? (Single Choice, required). Options: Fewer than 15; 15 to 100; More than 100; Not sure
- Question 9: Have you been offered a severance agreement? (Yes / No, required)
- Question 10: Have you filed a complaint with a government agency? (Yes / No, required)
- Question 11: Do you already have a lawyer for this? (Yes / No, required)
- Question 12: Briefly describe what happened (Long Text, required)
- Question 13: Upload any letters, emails or pay stubs (File, optional)
- Question 14: When is the best time to call you? (Single Choice, required). Options: Morning; Afternoon; Evening

## 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

## 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.