NREC Case Summary Form

Section 1: About you

Title

First name

Last name

Phone

Phone W

Phone M

Contact email address

Your Date of birth

Your ethnicity

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

Home Address 1

Home Address 2

Home Address 3

Town

Postcode

Section 2: Your case

Type of employer you intend to claim against

Job title

Brief description of your role

Date started

Are you still employed?

Yes

If no, what date did your employment end?

Were you taken on via an agency?

Yes

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

Yes

Are you a UK Citizen?

Yes

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, cat, phone, pension, etc

Number of people employed with you

Have you been subject to any form of discipline at work (e.g written or verbal warnings/suspension)

Yes

Have you lodged any grievances at work

Yes

If "Yes", please provide details

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

Yes

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

Yes

Number of hours worked per week:

Give details of any overtime

Section 3: Evidence your employer may possess

IMPORTANT – Are you aware of any evidence that your employer may be in possession of OR may seek by way of disclosure – that could change the advice we give you. This question is very important and should be answered truthfully:

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.

If you are aware of any such evidence please give details

Section 4: Looking for work

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

Yes

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

Please explain why e.g. medical reasons

Section 5: What type of case do you want to pursue?

Are there any other issues you might wish to discuss?

Most cases have to be brought within 3 months of the matter complained of. If you are too late, please explain why

Have you lodged a complaint already?

Yes

If no claim has been lodged within 3 months please explain why?

If so, when?

Additional notes

Checkboxes

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