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):

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:

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' Centre offers free legal information, not legal advice or representation.

Thanks for reaching out! An organizer will be in touch to set up a phone appointment.

Please note that wait times can vary.

Helping empower workers since 2017.

halifaxwac@gmail.com

902-221-0755

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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.

Subscribe for Updates

The Halifax Workers'
Action Centre

Before we assist you, please complete the following form.

All questions are asked to best assist you. All answers are kept private.