Freedom To Choose USA

Join the Fight to Stop Medical Mandates in California

Californians, sign up today to indicate your desire to take LEGAL ACTION against those who imposed unfair and illegal mandates upon you as of August, 2021. Whether or not mandates are lifted, the damage was already done to thousands of California workers, their families and dependents.

Employers acted irresponsibly, inappropriately and illegally, causing great harm to thousands of workers. Now, they must make reparations for their mistakes. The fact that many are going back to work today doesn’t erase rights violations committed by employers. We also need to send our city, county and state officials a message that this must NEVER happen again.

If you or your dependents were harmed in any way by unfair and illegal practices by your employer, and you’re ready to FIGHT BACK, enter your information below to be considered for current and future legal proceedings against employers in the public and private sectors. The information you volunteer below may all be part of your story and may be utilized in your future testimony and Declaration Statement.

Legal Form Instructions

Scroll down to view the Legal Form. This form may ultimately become the foundation of your testimony with which your legal team may base any possible claims for damages.

This form requires 30-60 minutes to fill out, and must be completed all at once. Once submitted, you cannot go back and edit.  Therefore, it is recommended that you read all of the questions first, then gather all the required information before entering your details.  We recommend using a laptop or desktop computer.

Depending upon your answers to the questions below, you may have to supply additional information in a screen that will drop down. When providing additional information, be detailed and truthful with your answers in order to clearly identify which legal rights were violated, by whom, and what damages you and your dependents suffered.

For instance, when describing adverse consequences at work, please specify when you learned of the adverse actions that would be taken, who advised you of same, i.e. name of your Department Head, Manager, Supervisor, and/or Human Resources or Personnel Representative, and have you filed a grievance concerning same.

Email Notes:

  • Use personal email addresses only. Do NOT enter an email address issued by your current or past employer, such as LA City, LA County, State of CA, DWP or .edu. 
  • Emails from iCloud, me.com, Outlook.com, MSN.com are blocking FreedomToChooseUSA.com emails, so please use an alternate personal email address. We suggest Protonmail (Proton.me).
  • Please “whitelist” Fight@FreedomToChooseUSA.com” so your auto-response from this form (as well as any other correspondence) doesn’t end up in your SPAM folder.
  • Check your SPAM folder REGULARLY for our emails. 
Form 3: Plaintiff Addl Info (4/17/23) (#38)
GENERAL INFORMATION
 
PREVIOUS & CURRENT EMPLOYMENT

Which ONE of the following categories best represents your Employer as of August, 2021? [City of Los Angeles (CITY), County of Los Angeles (COLA), Los Angeles Unified School District (LAUSD), Los Angeles County Office of Education (LACOE), State of California (STATE), (PRIVATE SECTOR) self-employed or non-public sector, or OTHER means ALL other Statewide, Public Sector Employers, Self Employed, Retired, Unemployed, etc.,].



Which ONE of the following categories best represents your Current Employer? [City of Los Angeles (CITY), County of Los Angeles (COLA), Los Angeles Unified School District (LAUSD), Los Angeles County Office of Education (LACOE), State of California (STATE),(PRIVATE SECTOR) self-employed or non-public sector, or OTHER means ALL other Statewide, Public sector Employers, Self Employed, Retired, Unemployed, etc.,].


 
DEPENDENT INFORMATION
 
SPOUSAL DEPENDENTS

Please enter information about your spouse, significant other, as well as divorced dependents. If you need more room for this, there is a field at the end of this section. 

 
CHILD & GRANDCHILD DEPENDENTS

Previously, we only asked for the initials for your identified child dependents. Now, the Court requires the first & last name for each of your identified child dependents, along with Date of Birth, in order to identify them. 

 
ELDERLY & DISABLED DEPENDENTS

Previously, we only asked for the initials for your identified elderly & disabled dependents. Now, the Court requires the first & last name for each of your identified dependents, along with Date of Birth, in order to identify them. 

 
OTHER DEPENDENTS

“Other” may mean sibling, significant other, etc. Please specify relationship in the Details. Previously, we only asked for the initials for your identified OTHER dependents. Now, the Court requires the first & last name for each of your identified OTHER dependents, along with Date of Birth, in order to identify them. 

 

 

YOUR CLAIM FOR DAMAGES & RIGHTS VIOLATIONS

ANSWER THE FOLLOWING 25 QUESTIONS TO HELP DETERMINE EXTENT OF HARM CAUSED

Education about our rights violations, how to stand up for our rights and then enforcement of our rights is at the core of our F2C Case. 

There are many Rights Violations identified in our Lawsuit, starting with the Violation of our Privacy and Denial of Equal Protection under the law, to name a few. 

Please read the lawsuit posted in the Resource Vault” on our website for the entire document. See 2nd Amended Complaint here. Even if only one of these Rights Violations occurred, your story matters. To share your story, answer the following questions in detail.

Depending upon your answers to the questions below, you may have to supply additional details in a field that will drop down.

When providing additional details, please provide as much relevant information as possible.

Describe Who? What? Where? When? How? Why?

For instance, when describing adverse consequences at work, please specify when you learned of the adverse actions that would be taken, who advised you of same, i.e. name of your Department Head, Manager, Supervisor, and/or Human Resources or Personnel Representative, and have you filed a grievance concerning same.

If you do not provide the requested information below in a timely manner, your file may not be escalated to the next steps in the court process and you may not be able to move forward with other Plaintiffs in the F2C Lawsuit. 

All requested information is voluntary; however, any future claim for damages is contingent on the information you provide to be complete. 

 

 

APPROVAL & CONFIRMATION

I confirm all the information submitted is accurate and true, and grant permission to both Helena Sunny Wise, Esq and Freedom To Choose LA to use this information for any and all future claims for damages or any other purposes of the Lawsuit, CASE# 21STCV45243, in which I am a PLAINTIFF.




Please sign digitally to indicate your approval.

 

 

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