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| EMPLOYMENT QUESTIONNAIRE – DISMISSAL |
- Tell us about your case as best you can by providing answers to the questions below.
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| 1 |
Title |
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| 2 |
First 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 |
Date of termination of employment (unless continuing) |
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| 10 |
Salary |
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| 11 |
Benefits (please list) |
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| 12 |
Did you resign or did your employer terminate your contract of employment? |
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| 13 |
What was the reason given? |
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| 14 |
Did you appeal? |
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| 15 |
What do you say about the circumstances in which your employment ended? |
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| 16 |
Were you subjected to any disciplinary action? |
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| 17 |
Describe the allegations against you |
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| 18 |
What do you say about the allegations? |
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| 19 |
Have you attended a disciplinary hearing? |
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| 20 |
If yes, what was the outcome? |
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| 21 |
Do you have any earlier disciplinary warnings on your record? |
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| 22 |
If so, on what dates were they issued and what for (identify all)? |
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| 23 |
Have you since got another job? |
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| 24 |
When did you start the job? |
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| 25 |
How much do you earn? |
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| 26 |
Are you owed any money by your employer? |
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| 27 |
What are you owed the money for [e.g. wages, commission, expenses etc.] [If so, answer questions 28 and 29 below] |
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| 28 |
How much are you owed? |
£ |
| 29 |
Describe here any additional complaints you have against your employer |
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| 30 |
Have you submitted a grievance to your employer? |
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| 31 |
Describe the outcome [If necessary, put “No outcome yet” if, for example, you are awaiting a grievance meeting] |
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| 32 |
Have you commenced any tribunal action in relation to the above? |
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| 33 |
If so, on what date did you file your claim? |
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| 34 |
Describe the stage that the proceedings have reached (specify the final hearing date if you have been notified of one) |
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| 35 |
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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