Conflict Check FormEmailThis field is for validation purposes and should be left unchanged.Name(Required)Email Address(Required) Phone Number(Required)Date of Termination(Required) Supervisor's Name(Required)The Employer & Corporate StructureTo determine the correct legal entities to name in a potential action, please provide the following:Direct Employer: (The name on your pay stub or W-2)NameSupervisor / Manager NameParent Company: (The company that owns your employer, if known)Subsidiary Companies: (Any related "child" companies involved in your fact pattern)The Aggressor(s)Please list the individuals who took the primary actions you are complaining of (e.g., the person who harassed, terminated, or discriminated against you, your supervisor's name, any other bad actors in your fact pattern).The Aggressor(s)Full NameJob Title/RoleRelationship to You Add RemoveWitnessesPlease list anyone who observed the events or whom you spoke with immediately after the incidents occurred.WitnessesFull NameContact Information (Email/Phone)What did they see/hear? Add RemoveInternal Decision MakersWere there any Human Resources representatives or upper-level managers involved in your reporting process or the final decision regarding your employment?ListNameTitle Add RemoveNote: Please provide the legal names of entities rather than "Doing Business As" (DBA) names if you have access to them. This ensures the accuracy of our initial filing research.Turnstile
