EMPLOYMENT QUESTIONNAIRE 3

Name*

First Last

Gender*

Male
Female
Prefer not to say
Prefer to self-describe

How do you self-describe?*

Address

E-mail address (where we may communicate freely with you)*

Enter Email Confirm Email

Telephone / Mobile (*optional)

Date of Birth*

Age

About your job

Job Title

Employment Commencement Date (please estimate if not known):

Please tick here only if your commencement date is estimated

Yes, I have estimated my commencement date

Notice Period you are required to give to your employer

Notice Period your employer has to give to you (if different from the above)

Date of Termination of employment (if applicable)

This will be the date your salary ceased, whether it is the date of expiry of your notice period, or where you have been paid in lieu of notice.

Are you on sick leave? If so, how long has this been for?

Reason for dismissal or resignation (if applicable)

Has any redundancy or settlement sum already been offered? If so, how much?

Employer’s Name

*optional at this stage

Nature of your employer's business

Contact Name of HR Person/Line Manager (or both)

*optional at this stage

Email address of the above contact

*optional at this stage

Your employer's address

Your place of work (if different from above field)

Employer's work address

Employer’s Telephone

*optional at this stage

Please state gross basic wage or salary per annum (before deduction of tax)

Please state basic take home pay per month (after deduction of tax)

Please specify any other benefits such as car allowance, medical cover etc.

Please give the number of normal basic hours worked each week

Bonus

Yes/No
Discretionary/fixed
% of salary

Shares or deferred stock. Please give details where appropriate.

Holiday outstanding (how many days)

Full history of events. Please try to be as brief a possible: (the box will automatically expand if you need more space)

Have you already spoken to someone at Landau Law? If so, please state their name.

This will enable us to direct your questionnaire quicker to the correct person.

How did you hear about us? If Internet-which site?

Upload any relevant documents

Drop files here or

Accepted file types: pdf, docx, jpg, Max. file size: 50 MB, Max. files: 6.

Email a copy of this completed questionnaire to me

Yes

Only tick this box if you would like a copy to be sent to your email address which you have entered at the beginning of this form. Please do not tick this box if you believe this is email address is not confidential to you, or you have entered a work email address.