Employee Submission Form
About yourself
First Name
*
Surname
*
Address
County
Postcode
Email
*
Tel:
daytime
evening
mobile
Your Situation
1
How long have you been with your current employer?
0
1
2
3
4
5
6
7
8
9
10+
years
1
2
3
4
5
6
7
8
9
10
11
12
months
2
Please tick if you have a written contract of employment.
3
Please tick if you have been dismissed.
4
Have you suffered any discriminatory treatment, on grounds of sex, race or disability?
(select all that apply)
Sex
Race
Disability
5
Please give a brief summary of the current situation and your aim:
*
required fields
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