Discrimination Contact Form

If you are over 40 years old and have been replaced by a younger worker or were passed over for a job or promotion based on your age, you may have a claim under the Age Discrimination in Employment Act (ADEA). Please contact our firm today to schedule a consultation with an employment law attorney who will provide a clear explanation of your legal rights and options.

Employment Law Attorneys - Red Bank, New Jersey

Have you been discriminated against by your employer because of your race, gender, age or disability? Have you been the victim of sexual harassment in the workplace?

Contact the employment law attorneys at Byrnes Kirkwood. We provide experienced and aggressive representation on behalf of employees throughout New Jersey. To contact our firm, call 732-219-7711, or contact us by e-mail.

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Name

Email Address

Phone Number

Business Phone

Cellular or Pager

Address

City

State

Zip

If you experienced discrimination in the workplace, what is your employer's name?

Employer's address, including county.

What type of business is it? (solo proprietorship, LLC, etc.)

If you experienced discrimination elsewhere, please describe where and under what circumstances the discrimination took place:

Please describe the discriminatory treatment:

If discrimination occurred in the workplace, are you still employed by this employer?
Yes No

If no, does the nature of your claim relate to wrongful termination?
Yes No

If yes, please describe:

If the discrimination relates to age, please provide us with your age:

Are you over 40 years of age?
Yes No

Please list any disabilities that you have:

If the discrimination relates to race or national origin, please list your race or national origin:

If the claim relates to harassment, please discuss the circumstances surrounding the allegations:

If the claim involves disparate wage treatment, please give:

Wages you were paid for the period involved:

Wages claimed:

Wage paid to others working performing same or similar tasks with similar training or experience:

Special concerns:

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Byrnes Kirkwood
28 Leroy Place | Red Bank, NJ 07701
Phone: 732-219-7711 | Fax: 732-219-7733
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We represent clients in New Jersey and New York, including Central New Jersey, Monmouth County, Middlesex County, Ocean County, Red Bank, Holmdel, Eatontown, Freehold, Asbury Park, Ocean, Shrewsbury, Middletown, Long Branch, Toms River, Lakewood, East Brunswick, Edison, Little Silver, Rumson, Fair Haven, Neptune, Colts Neck, Howell and Wall Township.

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