Our office will review your information and contact you via email if your case is selected. Please also submit an inquiry at Louisianaemploymentlawyers.org * First Name Last Name Email * Phone * (###) ### #### Type of Employment Discrimination Claim * Race Nationality Sex/Gender Sexual Harassment Pregnancy Disability Sexual Orientation Religion Age Retaliation for reporting or taking part in an investigation of any of the above Have you received a Right to Sue from the EEOC? * Yes No Not an Employment Discrimination Claim What is the date on your Right to Sue notice from the EEOC? MM DD YYYY Describe your claim. Highlight the discrimination as much as possible so we may properly assess it. * List Your position and Rate of Pay * Current Status * Laid Off/Terminated Still Employed By Same Company Found New Employer Name of Company You Are Filing Complaint Against * Did you receive a Position Statement From The EEOC yes no Thank you! Our office will review your information and contact you via email if we are able to accept your case.