Job Scam Intake & Consent Form

Section 1: Personal Information

Full Name

ID / Passport Number

Email Address

Phone Number

Residential Address

Section 2: Job Information

Job Title Applied For

Platform Where Job Was Posted

Indeed

CareerJunction

Gumtree

Facebook Jobs / Marketplace

WhatsApp / Telegram group

Other:

Section 3: Scam Details

How much money were you scammed for? (Amount and Currency)

What did the scammers request from you? (select all that apply)

Application / registration fees

Training / materials fees

Equipment purchase

Personal information (ID, bank details, etc.)

Other:

Do you have any supporting documentation? (e.g. screenshots, receipts)

Note: You can select multiple files. Please attach any proof you have.

Section 4: Timeline of Events

When did you see the job listing?

When did you make payment / share info?

When did you realize it was a scam?

Section 5: Reporting

Did you report this matter?

Yes

No

If yes, where did you report it? (select all that apply)

Police (SAPS / Local police)

Job platform (e.g., Indeed, LinkedIn)

Bank / Payment provider

Consumer Protection Authority

Other:

Section 6: Consequences

Were you able to find another legitimate job afterwards?

Yes

No

Still searching

What damages did you feel you incurred as a result of this scam?

Section 7: Legal Consent & Representation

I, , hereby confirm that the information provided above is true and correct to the best of my knowledge.

I authorize Justice & Co. to:

Represent me in legal action against the responsible parties, including job platforms that failed to properly vet job listings.
Seek compensation for damages incurred as a result of the fraudulent job listing(s).
Collect, store, and process my personal data and supporting documentation strictly for the purpose of litigation and related proceedings.

I understand that participation may involve being part of a group (class) action or individual claim and that my information will remain confidential except where disclosure is legally required.

I consent and authorize representation.