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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
Gross £ per (month,week, etc)
Net £ per (month,week, etc)
10 Benefits (please list)
11 Are you being subjected to any disciplinary action?
12 Describe the allegations against you
13 What do you say about the allegations?
 
14 Have you attended a disciplinary hearing?
15 If yes, what was the outcome?
     
16 Do you have any earlier disciplinary warnings on your record?
 
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]
     
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).