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    Untitled Document

    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 On what date were you made redundant?
    13 What was the reason given?
    14 Did you receive any warning that your job was at risk?
    15 Describe any consultations or meetings with your employer in respect of redundancy
    16 Describe any details you have about
    the selection criteria used by your employer
    17 Set out details of other employees doing the same or similar job to you and identify whether they have been made redundant
    18 Did you appeal?
    19 Have you since got another job?
    20 When did you start the job?
    21 How much do you earn?
    Gross £ per (month,week, etc)
    Net £ per (month,week, etc)
    22 Do you consider that you have been discriminated against by reason of your sex, race, age or disability or other reason
    23 What is your characteristic which you consider has given rise to this discrimination? [e.g. sex – female, race – black African, age – in my 60s, disability – multiple sclerosis etc.]?
    24 Describe in full what you consider to have constituted discrimination?
    25 Are you owed any money by your employer? If so answer questions 26 to 27
    26 What are you owed the money for [e.g. wages, commission, expenses etc.]
    27 How much are you owed? £
    28 Describe here any additional complaints you have against your employer
    29 Have you submitted a grievance to your employer?
    30 Describe the outcome
    [If necessary, put “No outcome yet” if, for example, you are awaiting a grievance meeting]
    31 Have you commenced any tribunal action in relation to the above?
    32 If so, on what date did you file your claim?
    33 Describe the stage that the proceedings have reached (specify the final hearing date if you have been notified of one)
    34 Do you have legal expenses insurance as part of your insurance policy that you have (e.g. home buildings or contents policies).