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The Halifax WAC
The Halifax Workers'
Action Centre
Halifax WAC:
Intake form
Before we assist you, please complete the following form.
All questions are asked to best assist you.
All answers are kept private.
First name:
Last name:
Email:
Phone number:
Employer name (will be kept private):
Pronouns
Job title:
Date you were hired:
Final day of employment (if applicable):
Employent type (select any/all that apply):
Full-time
Part-time
Casual
Short-term contract
Hired through a temp agency
Seasonal
Other
Immigration status:
Canadian citizen
Permanent resident
Work/student visa
Other
Are you a member of a union:
No
Yes
Unsure
How did you hear about us?
Dalhousie Legal Aid
Facebook
Instagram
Workers' Compensation
A lawyer/law firm
Internet search
Other
In your own words, briefly describe your workplace situation/question. We will discuss in more detail during your appointment:
If available, please provide any relevant documents (contracts, letter of termination etc.)
Upload File
Upload supported file (Max 15MB)
I understand that the Halifax Workers' Action Centre offers free legal information, not legal advice or representation.
Submit
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