National Association of Black Defenders

FORD MOTOR COMPANY – CHICAGO

Class Action Intake Form

Secure, confidential intake for current and former Ford Motor Company – Chicago employees.

Class Action Intake Questionnaire

100% Confidential

ProgressStep 1 of 6

Contact Information

Tell us how to reach you and confirm your preferred contact method.

Legal name *

Preferred name

Personal email *

Phone number *

Preferred contact method *

Best contact times *

Mailing address *

Ford Employment Information

Share your work history at the Ford Motor Company – Chicago as accurately as you can.

Ford employment status *

Work location *

Employment start date *

Employment end date

Department *

Job title *

Shift *

Union member? *

Union local

Supervisor or manager names *

Employment history details *

Workplace Conduct and Incidents

Describe the conduct, when it happened, whether it is ongoing, and how it affected you.

Conduct types *

Select all that apply.

Incident narrative *

Incident frequency *

Is the conduct ongoing? *

Impact details *

Reporting and Witnesses

Tell us whether you reported the issue, how it was handled, and who may have witnessed it.

Reporting channels *

Select all that apply.

Reporting response details *

Witnesses details *

Evidence and Legal History

Read how to send supporting materials, and share any prior legal involvement related to these issues.

Sending your evidence

NABD accepts supporting evidence by email only. Please do not attach files to this questionnaire.

Email your documents, photographs, recordings, messages, pay records, or schedules to info@nabd-justice.org. Send it from the same email address you entered on this form, and put your full legal name in the subject line. That is all we need to match your evidence to this questionnaire.

Please send your materials as soon as you are able. Review of your questionnaire typically takes about 7 to 14 days, and evidence that arrives during that period can be considered as part of it. Anything you send afterward is still added to your file.

Keep your own copies of everything you send, and continue preserving all relevant evidence.

Prior legal representation *

Damages and desired outcome *

Certifications and Signature

Please read each certification carefully before signing.

Confidentiality notice: Information shared here should be kept private, but there are limits to confidentiality and some information may need to be shared with NABD or authorized counsel for review.

Relationship notice: Submitting this form does not create an attorney-client relationship. Any decision to proceed will be made separately after review.

Evidence notice: Preserve messages, documents, photos, recordings, schedules, pay records, and any other relevant evidence.

Contact notice: NABD or authorized counsel may contact you if additional information is needed or if your submission may fit potential participation criteria.

I certify that the information I am providing is true and complete to the best of my knowledge. * I consent to NABD or authorized counsel reviewing my submission and contacting me using the details provided. * I acknowledge there are confidentiality risks when sharing information electronically. * I acknowledge this submission does not create an attorney-client relationship. * I acknowledge that I should preserve all relevant evidence, including texts, emails, documents, records, photos, and notes. *

Typed signature *

Signature date *

Class Action Intake Form

Class Action Intake Questionnaire

Thank you. Your intake has been received.