Richard J. Gonzalez Richard J. Gonzalez
Richard J. Gonzalez
Employment Lawyer

Discrimination /
   Wrongful Discharge Form
First Name:       Last Name:
Address:
City:    State:    Zip:
Home Phone:            Work Phone:
Cell Phone:        E Mail Address:
Fax Number:            Date of Birth:
Employer Name:
Your job title:
Brief discription
of employer's
discriminatory acts:
If disability discrimination,
describe nature and
extent of disability:
Amount of lost
wages suffered:		 Under $25,000
$25,000 to $50,0000
$50,000 to $100,000
More than $100,000
Best time and method
of contacting me is:
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©2002 Chicago-Kent College of Law, Illiniois Institute of Technology
565 W. Adams St., chicago, Illinois 60661-3691
Tel 312.906.5079; Fax 312.906.5299

Law Offices: rgonzale@kentlaw.edu