Initial Client Interview Form unit1
Initial Client Interview Form
A. CLIENT PERSONAL INFORMATION Name: Justin King Address: 123 Main Street, Chicago, Illinois 60601 Home Phone: (913)123-4567 Work Phone: (913)890-1234 Social Security Number: 123-45-6789 Driver’s License Number: IL39562243 Date of Birth: 7/14/83 Marital Status: Single Dependents: None Military Status: N/A Occupation: Student/Retail Employer Name, Address, Phone Number:
__________________________________________________________
Membership in Union or Professional Organization: N/A Police Record (if any): N/A Have you ever filed bankruptcy? If so, please explain. N/A
B. CLIENT EMPLOYMENT Type of Work: Retail Sales Job Title: Cashier Immediate Supervisor’s Name: Jill Janes Salary or Hourly Rate: $7.75/hour Number of Hours Worked Weekly - Before Accident 20 - After Accident 0
Benefits (Company car, pension plan, vacation, expense account, etc.)
N/A
D. CLIENT’S FACTS/STORY: BE AS DETAILED AS YOU CAN BE. INCLUDE DAMAGES AND ALL NAMES TOLD BY CLIENT
The client is Justin King, a winner of The “National Idol Regional Contest” last year on April 5th in Chicago, he was awarded a three year recording contract for $275,000 a year plus a percentage of sales with MCI Records. Mr. King further states that due to an accident on Interstate 57, just south of Chicago, he was unable to fulfill his contractual duties because of injuries sustained to his jaw and face. Mr. King goes on to state that on or around the 5th of April he had left his agents house after signing his contract. Mr. King states that he was driving his motorcycle on his way home. He said he was driving in the left hand lane going southbound on Interstate 57 when he noticed a beer truck going the same direction (he is unsure of the name it is either Coops, Coops Light, or Coops Ultra) and he suddenly notices a couple of cases of beer heading his direction. Mr. King stated he swerved left to
A. CLIENT PERSONAL INFORMATION Name: Justin King Address: 123 Main Street, Chicago, Illinois 60601 Home Phone: (913)123-4567 Work Phone: (913)890-1234 Social Security Number: 123-45-6789 Driver’s License Number: IL39562243 Date of Birth: 7/14/83 Marital Status: Single Dependents: None Military Status: N/A Occupation: Student/Retail Employer Name, Address, Phone Number:
__________________________________________________________
Membership in Union or Professional Organization: N/A Police Record (if any): N/A Have you ever filed bankruptcy? If so, please explain. N/A
B. CLIENT EMPLOYMENT Type of Work: Retail Sales Job Title: Cashier Immediate Supervisor’s Name: Jill Janes Salary or Hourly Rate: $7.75/hour Number of Hours Worked Weekly - Before Accident 20 - After Accident 0
Benefits (Company car, pension plan, vacation, expense account, etc.)
N/A
D. CLIENT’S FACTS/STORY: BE AS DETAILED AS YOU CAN BE. INCLUDE DAMAGES AND ALL NAMES TOLD BY CLIENT
The client is Justin King, a winner of The “National Idol Regional Contest” last year on April 5th in Chicago, he was awarded a three year recording contract for $275,000 a year plus a percentage of sales with MCI Records. Mr. King further states that due to an accident on Interstate 57, just south of Chicago, he was unable to fulfill his contractual duties because of injuries sustained to his jaw and face. Mr. King goes on to state that on or around the 5th of April he had left his agents house after signing his contract. Mr. King states that he was driving his motorcycle on his way home. He said he was driving in the left hand lane going southbound on Interstate 57 when he noticed a beer truck going the same direction (he is unsure of the name it is either Coops, Coops Light, or Coops Ultra) and he suddenly notices a couple of cases of beer heading his direction. Mr. King stated he swerved left to