"How much is your case really worth?"
	EMPLOYMENT TERMINATION CHECKLIST Please refer to "Read Me First" for guidance on completing the checklist information.

General

1. Case name, number and attorney position (P/D).
2. Attorney name.
3. Please provide a copy of the complaint.
4. Anticipated trial date.
5. Is there an allegation of plaintiff physical injury caused by the defendant?
   

1. Date of birth.
2. Gender and race (white, african-american, other).
3. Level of education attained (grade school, high school, college, graduate degree).

1. Name of prior employer.
2. Position held.
3. Date of original employment.
4. Date of employment termination.
5. Final rate of pay.
6. Period and amount by calendar year of unemployment and/or severance benefits received.
7. Date of each subsequent employment.
8. Name of each subsequent employer.
9. List calendar year income for 3 years prior to employment termination. Submit tax returns with W-2 forms, if available.
10. List calendar year income for all years subsequent to employment termination. Submit tax returns with W-2 forms, if available.
11. What is rate of pay in current position?
12. Did previous employer provide employee benefits, such as vacation, insurance pension plan, etc? Please describe. What were the required employee contributions, if any, for these benefits.
13. Does the current employer provide employee benefits, such as vacation, insurance pension plan, etc? Please describe. What are the required employee contributions, if any, for these benefits.
14. Please provide any documentation of benefits available from previous and current position including employee booklets, benefit statements, summary plan description, etc.
15. Do not submit performance appraisals, health insurance coverages, attendance records or other information not pertaining to economic loss.