EMPLOYMENT QUESTIONNAIRE – HARASSMENT

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

11

Benefits (please list)

12

Have you resigned?

YesNo

13

What reason(s) did you give for your resignation?

14

Describe in full what you consider to have constituted harassment?

15

Do you consider that you have been harassed by your employer or other colleagues? If colleagues set out any complaints to your employer and any action taken in response to such complaints

16

Have you submitted a grievance to your employer?

YesNo

17

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

18

Have you since got another job?

YesNo

19

When did you start the job?

20

How much do you earn?

21

Are you owed any money by your employer? If so answer questions 22 to 23

YesNo

22

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

23

How much are you owed?

£

24

Describe here any additional complaints you have against your employer

25

Have you commenced any tribunal action in relation to the above?

YesNo

26

If so, on what date did you file your claim?

27

Describe the stage that the proceedings have reached (specify the final hearing date if you have been notified of one)

28

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

YesNo