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Practice Areas

Employment Discrimination
Sexual Harassment & Retaliation
Wrongful Discharge
Employment Contracts
Family Medical Leave
Wage Claims
Disability Law
 
Gary M. Gilbert P.C.
8401 Colesville Rd., Suite 300 (map)
Silver Spring, MD 20910
 Telephone: 301.608.0880
Facsimile: 301.608-0881
 
 

Intake Form

  
Our firm provides assistance to private sector employees and employers with employment-related civil cases in Maryland. If you are interested in meeting with one of our attorneys, please complete the following information.
Incomplete forms are not accepted.
  Personal Information
Referred By:
Full Name:
Home Address:
City:   State: ZIP:
Home Phone: Cell Phone:
Email Home:
Gender: M: F:    Age: Date-of-Birth:
Home Contact:
  Work Information
Employer:
Work Phone:
Email Work:
Employer  Location: City:   State:
Job Title/Grade:
1st Line Supervisor:
2nd Line Supervisor:
Responsible Management:
  Complaint Information    (Use up to 3 Discrimination Claims)
Basis 1:
Describe:
Basis 2:
Describe:
Basis 3:
Describe:
  Important Dates - (please use MM/DD/YYYY )
Date of Most Recent Alleged Discriminatory Event
Most Recent EEO Counselor contact
ADR Requested
Union Grievance Filed
Notice of Right to File Formal EEO Complaint
Formal EEO Complaint Filed
MSPB Appeal Filed
Acknowledgement Letter & Counselor’s Report Received
Notice of Acceptance/Rejection Letter Received
If Complaint Rejected or Redefined,
Date Notice of Appeal/Petition filed with OFO
   
  Employment Claim Not Based on Allegations of Discrimination:
Pending Deadlines:
Conflict Statement: Have you had any previous contact with Gary Gilbert or the Law Office of Gary Gilbert and Associates? Yes:  No:
If Yes, what capacity
 
Thank you for completing this form. If you are not contacted within 2 business days, please contact our office and ask for an Intake Coordinator - 301.608.0880
 
   

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