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EMPLOYMENT QUESTIONNAIRE – DISCIPLINARY PROCEDURE |
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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. |
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1 |
Title |
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2 |
Full name (s) |
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3 |
Surname |
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4 |
Date of birth |
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5 |
Email address |
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6 |
Telephone number |
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7 |
What is the name of your employer/former employer |
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8 |
Date of commencement of employment |
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9 |
Salary |
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10 |
Benefits (please list) |
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11 |
Are you being subjected to any disciplinary action? |
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12 |
Describe the allegations against you |
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13 |
What do you say about the allegations? |
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14 |
Have you attended a disciplinary hearing? |
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15 |
If yes, what was the outcome? |
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16 |
Do you have any earlier disciplinary warnings on your record? |
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17 |
If so, on what dates were they issued and what for (identify all)? |
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18 |
Are you owed any money by your employer? [If so answer questions 19 and 20 below] |
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19 |
What are you owed the money for [e.g. wages, commission, expenses etc.] |
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20 |
How much are you owed? |
£ |
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21 |
Describe here any additional complaints you have against your employer |
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22 |
Have you submitted a grievance to your employer? |
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23 |
Describe the outcome [If necessary, put “No outcome yet” if, for example, you are awaiting a grievance meeting] |
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24 |
Do you have legal expenses insurance as part of your insurance policy that you have (e.g. home buildings or contents policies). |
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