Preliminary Client Intake Form ΔName Phone Number Email Please provide information about your job? What is the issue you're experiencing? - Select -Basic Rights - Employment StandardsHealth and SafetyHuman RightsI have a general question/concernDepending on your issue, please select the option that is most applicable from the options below. If you are experiencing multiple issues in multiple areas, you may select all that apply.Employment Standards - Basic Rights My issue is dealing with...Unpaid wages, illegal deductions, vacation, overtime, etcNot getting breaksMisclassification (independent contractor)Employer not giving Record Of EmploymentReprisal (negative outcome for asking about rights)TerminationSomething elseHealth and Safety My issue is dealing with...Violence and HarassmentWorking conditionsUnsafe work referalSomething else...Human Rights My issue is dealing with...Social ground and area (racism, gender, sexual orientiation, etc)During or Pre-employmentAccomodationSomething else...I just have a question or concern. Tell us what's going on. When is the best time to contact you? Please ensure that all of the information is correct. Allow 2-3 business days for us to contact you regarding your case.When you are finished, please click on the 'submit form' button below. Submit FormShare SWEACClick to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)
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