EMPLOYMENT QUESTIONNAIRE – DISCIPLINARY PROCEDURE

Tell us about your case as best you can by providing answers to the questions below.

If you have been dismissed please answer the dismissial questionnaire here instead.

1

Title

2

Full 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

Salary

10

Benefits (please list)

11

Are you being subjected to any disciplinary action?

YesNo

12

Describe the allegations against you

13

What do you say about the allegations?

14

Have you attended a disciplinary hearing?

YesNo

15

If yes, what was the outcome?

16

Do you have any earlier disciplinary warnings on your record?

YesNo

17

If so, on what dates were they issued and what for (identify all)?

18

Are you owed any money by your employer?  [If so answer questions 19 and 20 below]

YesNo

19

What are you owed the money for [e.g. wages, commission, expenses etc.]

20

How much are you owed?

£

21

Describe here any additional complaints you have against your employer

22

Have you submitted a grievance to your employer?

23

Describe the outcome
[If necessary, put “No outcome yet” if, for example, you are awaiting a grievance meeting]

24

Do you have legal expenses insurance as part of your insurance policy that you have (e.g. home buildings or contents policies).

YesNo