Unemployment Information Form

I, (the "Client"), retain and employ Richard Celler Legal, P.A. d/b/a "TheUnemploymentLawyers.com" ("The Firm") as my attorneys to represent me in my unemployment compensation appeal hearing against ("My Former Employer"). The scope of this retainer is limited to The Firm preparing for, and attending the telephonic unemployment hearing on my behalf. The Client shall remain solely responsible for complying with any and all requirements imposed on the Client by the State of Florida's Unemployment Division to remain eligible for, and receive unemployment benefits, including, but not limited to, filing for unemployment benefits, submitting any and all requested documentation including work search records, and otherwise attending any and all telephonic or other hearings regarding unemployment benefits. The Firm shall not be responsible for the dismissal of the Client's claim for unemployment benefits based upon the Client's failure/refusal to timely submit documents to the State of Florida regarding his/her claim for unemployment benefits, or misstatements or untruths made by the Client to the State of Florida.

In regard to attorney's fees, the Firm has agreed to accept this limited representation on a flat fee basis of $349.00 I have been advised that I will not have to pay the Firm any other monies. The payment of this flat fee is compensation for the Firm's time spent on representing the Client at the unemployment compensation appeal hearing, and is no way intended to guarantee any result of outcome of the hearing. The Client understands that this flat fee payment is not contingent on the result of the outcome of the unemployment compensation appeal hearing, as the Firm has no ability to modify the facts as they occurred at the time of, or prior to the Client's termination of employment. Should the Client attempt to stop payment on the monies paid to the Firm after the Firm has provided services to the Client, this Retainer Agreement shall serve as proof that the Client approved such payment and agreed that the nature of the payment was for time incurred, and is not refundable.

Upon investigation of my claims, should the Firm wish at any time to withdraw from this Retainer based upon the unlikelihood of success for the Client, untruthful or deceitful conduct by the Client, or any other reason, they shall have the right to do so and will refund/credit back all monies paid by Client in a timely manner. Client further agrees to keep the Firm informed of my whereabouts, and to continually inform the Firm of my current mailing address and contact information. The Client understands that if I become unavailable, and the Firm cannot locate me for a period of thirty (30) days, this will mean that I no longer am interested in pursuing my claims, and the Firm may withdraw from representation and, under this circumstance, no refund of monies paid shall be permitted.

I agree that, if I decide to terminate this contract, discharge my counsel and/or choose to no longer pursue my claim, no refund shall be issued for the time incurred by the Firm on your behalf.