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EMPLOYMENT QUESTIONNAIRE – DISMISSAL
 
  • Tell us about your case as best you can by providing answers to the questions below.
 
1 Title
2 First name(s)
3 Surname
4 Date of birth
5 Email address
6 Telephone number
7 What is the name of your employer/former employer?
8 Date of commencement of employment
9 Date of termination of employment (unless continuing)
10 Salary
Gross £ per (month,week, etc)
Net £ per (month,week, etc)
11 Benefits (please list)
12 Did you resign or did your employer terminate your contract of employment?
13 What was the reason given?
14 Did you appeal?
15 What do you say about the circumstances in which your employment ended?
16 Were you subjected to any disciplinary action?
17 Describe the allegations against you
18 What do you say about the allegations?
19 Have you attended a disciplinary hearing?
20 If yes, what was the outcome?
21 Do you have any earlier disciplinary warnings on your record?
22 If so, on what dates were they issued and what for (identify all)?
23 Have you since got another job?
24 When did you start the job?
25 How much do you earn?
Gross £ per (month,week, etc)
Net £ per (month,week, etc)
26 Are you owed any money by your employer?
27 What are you owed the money for
[e.g. wages, commission, expenses etc.]
[If so, answer questions 28 and 29 below]
28 How much are you owed? £
29 Describe here any additional complaints
you have against your employer
30 Have you submitted a grievance to your employer?
31 Describe the outcome
[If necessary, put “No outcome yet”
if, for example, you are awaiting a grievance meeting]
32 Have you commenced any tribunal action in relation to the above?
33 If so, on what date did you file your claim?
34 Describe the stage that the proceedings have reached
(specify the final hearing date if you have been notified of one)
35 Do you have legal expenses insurance as part of your
insurance policy that you have (e.g. home buildings or contents policies).