The Next Step

Please take the time to complete this questionnaire as accurately as possible. To effectively represent you, we will need as much relevant information as you can provide from the very start. This questionnaire will form the basis of your case. If we do not have full details of your case now, it may not be possible to make a claim for all of your losses at a later stage.

Please provide all monetary values in pounds sterling (£).

Section 1:

Personal Details

Title

First Name

(required)

Last Name

(required)

Date of Birth

Place of Birth (country)

National Insurance No.

Please provide the details where you are most likely to be contactable:

Address

(required)

Phone (Work)

Phone (Home)

Phone (Mobile)

(required)

Section 2:

Legal Insurance

Have you checked your home insurance policies for legal cover?

Yes No

Do you have legal expenses cover that may cover a Tribunal claim?

Yes No

If yes, please provide the name of the insurer

Address of insurer

Policy number

Name of policy holder

Have you submitted an application from the insurer yet?

Yes No

If yes, have the insurers said that they will cover the claim?

Yes No

Section 3:

Your Case

Name of employer you intend to claim against

Address of employer (give registered address if a limited company)

Address where you worked

Job title

Please provide a description of your role

Date started

Are you still employed?

Yes No

If no, what date did your employment end?

Please provide details of any breaks in employment

Were you taken on via an agency?

Yes No

Have you worked for your employer on a "self employed" basis?

Yes No

What is your immigration status?

Pay: Gross per annum

Take home pay (Net pay) per month

Please provide details of any bonuses, including amount and how often they were received

Please provide details of any benefits. For example, car, phone, pension, etc.

Number of people employed with you

Your line manager

Have you been subject to any form of discipline at work (eg written or verbal warnings/ suspension)?

Yes No

Have you lodged any grievances at work?

Yes No

Have you ever been involved in any previous court or tribunal cases?

Yes No

Number of hours worked per week

Overtime

Does your employer pay all of your tax and National Insurance for you?

Yes No

Are you aware of any failings by your employer to pay tax and National Insurance?

Yes No

Section 4:

Damaging Evidence

If you are aware of any evidence that your employer might have (or might request) which could damage your case or credibility, you must tell us below. Such evidence may include:

Compromising emails that you may have sent to or from work (whether or not they have been deleted)
Criminal records
Previous problems at work (including other places of employment)
Documents that may damage your case
Any claim, which your employer might have against you - eg negligence or any other monetary claim.

Are you aware of any such evidence?

Yes No

If yes, please provide details

Section 5:

Looking for work

Since losing your job, have you been looking for work?

Yes No

If yes, please provide details of your efforts to find a job, including applications, adverts, job centre records and diaries.

If no, please explain why (eg medical reasons)

Section 6:

Type of Case

It is important to fully state your case when we lodge your claim as you may be prevented from doing so later.

Please tick any of the following that you would like to discuss

	Dismissal
	Constructive dismissal (resignation due to your employer's breach of contract)
	Notice entitlement
	Race discrimination
	Sex discrimination
	Disability discrimination
	Religious belief discrimination
	Sexual orientation discrimination
	Injury at work
	Stress related injury at work
	The number of hours you work
	Deductions from your pay
	References
	Leave entitlements
	Terms in your contract of employment
	Bullying or harassment at work
	Anything else

Please describe anything else you would like to discuss

Most cases have to be brought within three months of the matter complained of. If you are too late, please be prepared to explain why. Should the incident you are complaining about be over three months ago, please phone us before your appointment.

Have you lodged a complaint already?

Yes No

If you have answered yes to the previous question, please fax or email the claim form (IT1) with any defence lodged by your employer in form IT3 to us using out contact details.

Section 7:

Helpful Evidence

Please think about how we might prove the key elements of your case. This evidence may be in the form of documents or witnesses. Please provide details below.

Please indicate if you have any of the following documents. Select You if you have it, Emp if your employer has it, or N if you do not have it or are unsure.

	You	Emp	N
Contracts of employment
Job descriptions
Disciplinary notes and procedures
Warnings
Relevant memos
Letters of dismissal
Tribunal or court documents
Medical reports
Wage slips
Diaries
Evidence
Appraisals

If you know of any witnesses, please provide their full name, date of birth, phone number, address and a note of what they might say. Existing employees might require a witness order.

Witness 1: Name

Date of birth

Occupation

Address

Evidence

Witness 2: Name

Date of birth

Occupation

Address

Evidence

We need to know, from the outset, what you hope to achieve. Please let us know which of the following you hope to achieve.

Tick the appropriate box(es) for what you hope to achieve

	A reference
	Financial compensation
	Your job back
	Relocation
	Other

If you ticked 'other', please provide a brief description of what you hope to achieve

If there are any medical issues, please provide you GP's details below. Medical reports may be served on your opponent or sent to the Tribunal.

GP's full name

GP's address

Section 8:

Statement of Case

We need you to say in your own words “what happened” that has led to you contacting us seeking assistance. It would be useful if this could be in chronological order setting out all relevant dates and what happened on those dates. This statement needs to set out the nature of your grievance and claim. We are only interested in the FACTS as they happened. Leave the legal issues to us.

If you prefer, you may send us a pre-prepared a statement, in Microsoft Word, WordPad or Notepad formats. (Maximum file size of 512Kb)

Your statement

Document to send

Section 9:

Where did you find us?

To assist us with our Market Research, could you please indicate how you found this site? If you used a search engine, could you let us know which one, and what keyword(s) you used?

How you found us

The key search phrase or word used

You now need to click 'Send Information', below, which will send your information to an employment law solicitor. Thank you for taking the time to complete this questionnaire. It will help us deal with your enquiry more speedily.