Birmingham City Council
Imposed Contracts of Employment
Questionnaire
FULL NAME: ……………………………………………………………………………………….
ADDRESS: …………………………………………………………………………………............
………………………………………………………………………………………………………..
………………………………………………………………………………………………………..
CONTACT NO: ………………………
……………………………………………………………
EMAIL ADDRESS: …………………………………………………………………………………
GMB MEMBERSHIP
NUMBER (if known):
……………………………………………………..
DATE OF BIRTH: ……………………………………………………………………....................
NAME AND
ADDRESS OF YOUR PLACE OF WORK:
……………………………………………………………………………………………………….
……………………………………………………………………………………………………….
JOB TITLE: ……………………………………………………………………………………….
COMMENCEMENT
OF EMPLOYMENT DATE:
……………………………………………….
HOW MANY
HOURS YOU WORK PER WEEK?
……………………………………………….
NORMAL TAKE
HOME PAY ON OLD CONTACT (including overtime, bonuses
etc)
* please delete
as appropriate
……………………….………………………………… per *week / month
NORMAL TAKE
HOME PAY ON NEW CONTACT (including overtime, bonuses etc)
* please delete
as appropriate
……………………….………………………………… per *week / month
DID YOU SIGN
TO ACCEPT THE NEW CONTRACT? YES□
NO□
DETAILS OF
ANY CHANGES YOU HAVE EXPERIENCED SINCE THE NEW CONTRACT HAS BEEN IN PLACE:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
DID THE AUTHORITY WRITE TO YOU STATING THAT THEY WERE IMPOSING THE NEW CONTACT?
YES □
NO □
DID YOU SUBMIT A LETTER OBJECTING TO THE CHANGE OF CONTRACT?
YES □ NO □
HAVE YOU SUBMITTED AN APPEAL IN RELATION TO YOUR NEWLY ALLOCATED PAY BAND?
YES □
NO □
SINCE YOUR NEWLY ALLOCATED PAY BAND HAVE YOU HAVE BEEN THE SUBJECT OF PROTECTION?
YES □
NO □
DID YOU RECEIVE THE PAY RISE DUE IN DECEMBER 2007?
YES □
NO □
The above information is provided to the best of my knowledge is true and accurate and I provide this information because
I wish EAD to submit an unfair dismissal and/or unlawful deduction Employment Tribunal Claim on my behalf.
Signed: ………………………………………………………………………………………
Date: …………………………………………………………………………………………