{"id":1933,"date":"2012-10-25T09:50:48","date_gmt":"2012-10-25T09:50:48","guid":{"rendered":"http:\/\/nationwideemploymentlawyers.co.uk\/?page_id=1933"},"modified":"2022-08-26T14:00:18","modified_gmt":"2022-08-26T14:00:18","slug":"questionnaire","status":"publish","type":"page","link":"https:\/\/natemplaw.co.uk\/employee-services\/questionnaire\/","title":{"rendered":"Nationwide Employment Lawyers Questionnaire"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_6' style='display:none'><div id='gf_6' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_6'  action='https:\/\/natemplaw.co.uk\/wp-json\/wp\/v2\/pages\/1933' data-formid='6' >\n        <div id='gf_progressbar_wrapper_6' class='gf_progressbar_wrapper'>\n        \t<h3 class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>4<\/span>\n        \t<\/h3>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_25' style='width:25%;'><span>25%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_6_1' class='gform_page ' >\n                                    <div class='gform_page_fields'><ul id='gform_fields_6' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_6_22\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_22\"><h2 class=\"gsection_title\">Personal Details<\/h2><\/li><li id=\"field_6_23\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_23\"><label class='gfield_label gform-field-label' for='input_6_23' >1. Title (Mr, Mrs, Miss, Ms, Other)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_6_23' type='text' value='' class='medium'   tabindex='3500'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_24\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_24\"><label class='gfield_label gform-field-label' for='input_6_24' >2. First Name (or names)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_6_24' type='text' value='' class='medium'   tabindex='3501'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_25\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_25\"><label class='gfield_label gform-field-label' for='input_6_25' >3. Surname (or names)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_6_25' type='text' value='' class='medium'   tabindex='3502'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_26\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_26\"><label class='gfield_label gform-field-label'  >4. Gender (male or female)<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_6_26'>\n\t\t\t<li class='gchoice gchoice_6_26_0'>\n\t\t\t\t<input name='input_26' type='radio' value='Male'  id='choice_6_26_0' tabindex='3503'   \/>\n\t\t\t\t<label for='choice_6_26_0' id='label_6_26_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_6_26_1'>\n\t\t\t\t<input name='input_26' type='radio' value='Female'  id='choice_6_26_1' tabindex='3504'   \/>\n\t\t\t\t<label for='choice_6_26_1' id='label_6_26_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_6_27\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_27\"><label class='gfield_label gform-field-label' for='input_6_27' >5. Address: house number or name<\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_6_27' type='text' value='' class='medium'   tabindex='3505'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_28\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_28\"><label class='gfield_label gform-field-label' for='input_6_28' >Street<\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_6_28' type='text' value='' class='medium'   tabindex='3506'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_29\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_29\"><label class='gfield_label gform-field-label' for='input_6_29' >Town\/City<\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_6_29' type='text' value='' class='medium'   tabindex='3507'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_30\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_30\"><label class='gfield_label gform-field-label' for='input_6_30' >Country<\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_6_30' type='text' value='' class='medium'   tabindex='3508'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_31\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_31\"><label class='gfield_label gform-field-label' for='input_6_31' >Postcode<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_6_31' type='text' value='' class='medium'   tabindex='3509'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_32\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_32\"><label class='gfield_label gform-field-label' for='input_6_32' >6. Phone number (including area code)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_6_32' type='text' value='' class='medium'   tabindex='3510'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_33\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_33\"><label class='gfield_label gform-field-label' for='input_6_33' >7. Mobile number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_6_33' type='text' value='' class='medium'   tabindex='3511'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_34\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_34\"><label class='gfield_label gform-field-label' for='input_6_34' >8. Email address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_6_34' type='text' value='' class='medium'   tabindex='3512'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_35\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_35\"><h2 class=\"gsection_title\">Details of organisation you are claiming against<\/h2><\/li><li id=\"field_6_36\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_36\"><label class='gfield_label gform-field-label' for='input_6_36' >9. Name of your employer\/ organisation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_6_36' type='text' value='' class='medium'   tabindex='3513'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_37\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_37\"><label class='gfield_label gform-field-label' for='input_6_37' >10. Address: Name or Number<\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_6_37' type='text' value='' class='medium'   tabindex='3514'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_38\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_38\"><label class='gfield_label gform-field-label' for='input_6_38' >Street<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_6_38' type='text' value='' class='medium'   tabindex='3515'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_39\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_39\"><label class='gfield_label gform-field-label' for='input_6_39' >Town\/City<\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_6_39' type='text' value='' class='medium'   tabindex='3516'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_89\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_89\"><label class='gfield_label gform-field-label' for='input_6_89' >Country<\/label><div class='ginput_container ginput_container_text'><input name='input_89' id='input_6_89' type='text' value='' class='medium'   tabindex='3517'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_40\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_40\"><label class='gfield_label gform-field-label' for='input_6_40' >Postcode<\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_6_40' type='text' value='' class='medium'   tabindex='3518'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_41\"  class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_41\"><label class='gfield_label gform-field-label' for='input_6_41' >11. Phone number<\/label><div class='gfield_description' id='gfield_description_6_41'>Note: if there is more than one organisation then please provide their details (same as above) on a separate sheet of paper.  <\/div><div class='ginput_container ginput_container_text'><input name='input_41' id='input_6_41' type='text' value='' class='medium'  aria-describedby=\"gfield_description_6_41\" tabindex='3519'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_105\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_105\"><label class='gfield_label gform-field-label' for='input_6_105' >12. Job Title<\/label><div class='ginput_container ginput_container_text'><input name='input_105' id='input_6_105' type='text' value='' class='medium'   tabindex='3520'   aria-invalid=\"false\"   \/> <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_6_21' class='gform_next_button gform-theme-button button' value='Next' tabindex='3521' onclick='jQuery(\"#gform_target_page_number_6\").val(\"2\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_6\").val(\"2\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_2' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_6_2' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_6_94\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_94\"><label class='gfield_label gform-field-label'  >13. Have you been dismissed from your employment?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_6_94'>\n\t\t\t<li class='gchoice gchoice_6_94_0'>\n\t\t\t\t<input name='input_94' type='radio' value=''  id='choice_6_94_0' tabindex='3522'   \/>\n\t\t\t\t<label for='choice_6_94_0' id='label_6_94_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_6_94_1'>\n\t\t\t\t<input name='input_94' type='radio' value='No'  id='choice_6_94_1' tabindex='3523'   \/>\n\t\t\t\t<label for='choice_6_94_1' id='label_6_94_1' class='gform-field-label gform-field-label--type-inline'>No (selecting 'No' skips the next 3 questions)<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_6_97\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_97\"><h2 class=\"gsection_title\">Dismissal<\/h2><\/li><li id=\"field_6_1\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_1\"><label class='gfield_label gform-field-label' for='input_6_1' >14. When were you dismissed from your employment?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_6_1'>(There is a three month time limit to bring the claim. However, in limited circumstances the Employment Tribunal may set this time limit aside.)<\/div><div class='ginput_container ginput_container_text'><input name='input_1' id='input_6_1' type='text' value='' class='medium'  aria-describedby=\"gfield_description_6_1\" tabindex='3524'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_2\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_2\"><label class='gfield_label gform-field-label' for='input_6_2' >15. What was your salary at the time of dismissal (including bonuses and any commission) per month and per annum?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_6_2' type='text' value='' class='medium'   tabindex='3525'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_5\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_5\"><label class='gfield_label gform-field-label' for='input_6_5' >16. Please also state what benefits were you in receipt of at the time of your dismissal (e.g. pension, medical insurance, company car, season ticket loan etc) and any values where known.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_5' id='input_6_5' class='textarea medium' tabindex='3526'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_6_104\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_104\"><h2 class=\"gsection_title\">Any other acts<\/h2><\/li><li id=\"field_6_113\"  class=\"gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_113\"><label class='gfield_label gform-field-label' for='input_6_113' >17. When did the acts you wish to complain about occur?<\/label><div class='gfield_description' id='gfield_description_6_113'>(There is a three month time limit to bring the claim. However, in limited circumstances the Employment Tribunal may set this time limit aside.)\n<\/div><div class='ginput_container ginput_container_text'><input name='input_113' id='input_6_113' type='text' value='' class='medium' maxlength='140 ' aria-describedby=\"gfield_description_6_113\" tabindex='3527'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_102\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_102\"><label class='gfield_label gform-field-label'  >18. Have you suffered any other act during your employment?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_6_102'>\n\t\t\t<li class='gchoice gchoice_6_102_0'>\n\t\t\t\t<input name='input_102' type='radio' value=''  id='choice_6_102_0' tabindex='3528'   \/>\n\t\t\t\t<label for='choice_6_102_0' id='label_6_102_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_6_102_1'>\n\t\t\t\t<input name='input_102' type='radio' value=''  id='choice_6_102_1' tabindex='3529'   \/>\n\t\t\t\t<label for='choice_6_102_1' id='label_6_102_1' class='gform-field-label gform-field-label--type-inline'>No (selecting 'No' skips the next next question)<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_6_96\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_96\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_6_101\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_101\"><label class='gfield_label gform-field-label' for='input_6_101' >19. How long have you been employed for?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_101' id='input_6_101' type='text' value='' class='medium'   tabindex='3530'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_11\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_11\"><label class='gfield_label gform-field-label' for='input_6_11' >21. Do you have funds to pay fees? If so, what level of fees can you afford to pay? (this will allow us to obtain the best lawyer in your fee bracket)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_11' id='input_6_11' class='textarea medium' tabindex='3531'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_6_17\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_17\"><h2 class=\"gsection_title\">22. Have you already issued an Employment Tribunal application (ET1)?<\/h2><\/li><li id=\"field_6_18\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_18\"><label class='gfield_label gform-field-label' for='input_6_18' >If so please tell us the date of the hearing<\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_6_18' type='text' value='' class='medium'   tabindex='3532'   aria-invalid=\"false\"   \/> <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_6_42' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous' tabindex='3533' onclick='jQuery(\"#gform_target_page_number_6\").val(\"1\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_6\").val(\"1\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_6_42' class='gform_next_button gform-theme-button button' value='Next' tabindex='3534' onclick='jQuery(\"#gform_target_page_number_6\").val(\"3\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_6\").val(\"3\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_3' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_6_3' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_6_43\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_43\"><h2 class=\"gsection_title\">Employment details<\/h2><\/li><li id=\"field_6_44\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_44\"><label class='gfield_label gform-field-label' for='input_6_44' >23. Date you started your employment<\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_6_44' type='text' value='' class='medium'   tabindex='3535'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_45\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_45\"><label class='gfield_label gform-field-label'  >24. Is your employment continuing?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_6_45'>\n\t\t\t<li class='gchoice gchoice_6_45_0'>\n\t\t\t\t<input name='input_45' type='radio' value='Yes'  id='choice_6_45_0' tabindex='3536'   \/>\n\t\t\t\t<label for='choice_6_45_0' id='label_6_45_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_6_45_1'>\n\t\t\t\t<input name='input_45' type='radio' value='No'  id='choice_6_45_1' tabindex='3537'   \/>\n\t\t\t\t<label for='choice_6_45_1' id='label_6_45_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_6_46\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_46\"><label class='gfield_label gform-field-label' for='input_6_46' >If \u2018Yes\u2019 then when will it stop?<\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_6_46' type='text' value='' class='medium'   tabindex='3538'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_57\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_57\"><label class='gfield_label gform-field-label' for='input_6_57' >25. Have you received any other payment from your former employer? If yes, please give details<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_57' id='input_6_57' class='textarea medium' tabindex='3539'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_6_59\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_59\"><label class='gfield_label gform-field-label' for='input_6_59' >26. How much do you or did you get paid before tax each week?<\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_6_59' type='text' value='' class='medium'   tabindex='3540'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_114\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_114\"><label class='gfield_label gform-field-label' for='input_6_114' >27. Have you got another job or side business?<\/label><div class='ginput_container ginput_container_text'><input name='input_114' id='input_6_114' type='text' value='' class='medium'   tabindex='3541'   aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_6_63\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_63\"><label class='gfield_label gform-field-label' for='input_6_63' >How much do you or will you get paid in this new job before tax? (weekly\/monthly\/yearly)<\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_6_63' type='text' value='' class='medium'   tabindex='3542'   aria-invalid=\"false\"   \/> <\/div><\/li><\/ul>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_6_67' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous' tabindex='3543' onclick='jQuery(\"#gform_target_page_number_6\").val(\"2\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_6\").val(\"2\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_6_67' class='gform_next_button gform-theme-button button' value='Next' tabindex='3544' onclick='jQuery(\"#gform_target_page_number_6\").val(\"4\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_6\").val(\"4\");  jQuery(\"#gform_6\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_4' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_6_4' class='gform_fields top_label form_sublabel_below description_above'><li id=\"field_6_71\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_71\"><h2 class=\"gsection_title\">Discrimination<\/h2><\/li><li id=\"field_6_74\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_74\"><label class='gfield_label gform-field-label'  >28. Do you believe that you have been treated unfairly or less favourably than a colleague because of your age, race, sex, religion\/belief, disability or sexual orientation?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_6_74'>\n\t\t\t<li class='gchoice gchoice_6_74_0'>\n\t\t\t\t<input name='input_74' type='radio' value='Yes'  id='choice_6_74_0' tabindex='3545'   \/>\n\t\t\t\t<label for='choice_6_74_0' id='label_6_74_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_6_74_1'>\n\t\t\t\t<input name='input_74' type='radio' value='No'  id='choice_6_74_1' tabindex='3546'   \/>\n\t\t\t\t<label for='choice_6_74_1' id='label_6_74_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_6_77\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_77\"><label class='gfield_label gform-field-label'  >29. Does your claim relate to \u2018whistleblowing\u2019 (protected disclosure)?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_6_77'>\n\t\t\t<li class='gchoice gchoice_6_77_0'>\n\t\t\t\t<input name='input_77' type='radio' value='Yes'  id='choice_6_77_0' tabindex='3547'   \/>\n\t\t\t\t<label for='choice_6_77_0' id='label_6_77_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_6_77_1'>\n\t\t\t\t<input name='input_77' type='radio' value='No'  id='choice_6_77_1' tabindex='3548'   \/>\n\t\t\t\t<label for='choice_6_77_1' id='label_6_77_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_6_78\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_78\"><h2 class=\"gsection_title\">Your Claim<\/h2><\/li><li id=\"field_6_80\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_80\"><label class='gfield_label gform-field-label' for='input_6_80' >30. Please provide us with details of your claim and of event\/s you are complaining about (include dates and times where known) below<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_80' id='input_6_80' class='textarea medium' tabindex='3549'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_6_81\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_81\"><label class='gfield_label gform-field-label' for='input_6_81' >31. What compensation or remedy you are seeking? (for example financial or re-instatement) (optional)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_81' id='input_6_81' class='textarea medium' tabindex='3550'    aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_6_82\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_82\"><label class='gfield_label gform-field-label'  >32. Do you have insurance to cover the costs of your claim?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_6_82'>(Please check your home insurance policy for legal expenses insurance for Employment matters)<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_6_82'>\n\t\t\t<li class='gchoice gchoice_6_82_0'>\n\t\t\t\t<input name='input_82' type='radio' value='Yes'  id='choice_6_82_0' tabindex='3551'   \/>\n\t\t\t\t<label for='choice_6_82_0' id='label_6_82_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_6_82_1'>\n\t\t\t\t<input name='input_82' type='radio' value='No'  id='choice_6_82_1' tabindex='3552'   \/>\n\t\t\t\t<label for='choice_6_82_1' id='label_6_82_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_6_83\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_83\"><label class='gfield_label gform-field-label'  >33. Do you suffer from any disability?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_6_83'>\n\t\t\t<li class='gchoice gchoice_6_83_0'>\n\t\t\t\t<input name='input_83' type='radio' value='Yes'  id='choice_6_83_0' tabindex='3553'   \/>\n\t\t\t\t<label for='choice_6_83_0' id='label_6_83_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_6_83_1'>\n\t\t\t\t<input name='input_83' type='radio' value='No'  id='choice_6_83_1' tabindex='3554'   \/>\n\t\t\t\t<label for='choice_6_83_1' id='label_6_83_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_6_84\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_84\"><label class='gfield_label gform-field-label' for='input_6_84' >If Yes, what can we do to assist you in this process e.g. send documents with plenty of time to read\/respond, use larger fonts, correspond in writing rather than by telephone<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_84' id='input_6_84' class='textarea medium' tabindex='3555'     aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_6_85\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_85\"><label class='gfield_label gform-field-label'  >34. Are you receiving any state benefits?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_6_85'>\n\t\t\t<li class='gchoice gchoice_6_85_0'>\n\t\t\t\t<input name='input_85' type='radio' value='Yes'  id='choice_6_85_0' tabindex='3556'   \/>\n\t\t\t\t<label for='choice_6_85_0' id='label_6_85_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_6_85_1'>\n\t\t\t\t<input name='input_85' type='radio' value='No'  id='choice_6_85_1' tabindex='3557'   \/>\n\t\t\t\t<label for='choice_6_85_1' id='label_6_85_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_6_86\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_86\"><label class='gfield_label gform-field-label' for='input_6_86' >If Yes, then please provide details and the amount which you are receiving (weekly\/monthly\/yearly)<\/label><div class='gfield_description' id='gfield_description_6_86'>Please can you also ensure that you have copies of the following documents which we may need:\n\n<p>1. Employee Handbook\/Contract of Employment\n\n<p>2. Any letter of Grievance\/copies of documents used in any grievance procedure\n\n<p>3. Letter of severance<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_86' id='input_6_86' class='textarea medium' tabindex='3558' aria-describedby=\"gfield_description_6_86\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_6_93\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_6_93\"><label class='gfield_label gform-field-label' for='input_6_93' >Email address you would like us to respond to<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_93' id='input_6_93' type='text' value='' class='medium' tabindex='3559'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><\/ul><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_6' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' value='Previous' tabindex='3560' onclick='if(window[\"gf_submitting_6\"]){return false;}  window[\"gf_submitting_6\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_6\"]){return false;} window[\"gf_submitting_6\"]=true;  jQuery(\"#gform_6\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_6' class='gform_button button' value='Submit' tabindex='3561' onclick='if(window[\"gf_submitting_6\"]){return false;}  window[\"gf_submitting_6\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_6\"]){return false;} window[\"gf_submitting_6\"]=true;  jQuery(\"#gform_6\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_6' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='6' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_6' value='WyJbXSIsImMzZjM1ZGM5YzYzNDk2M2RmOWFiOWVmOTk3YmE3Mzg1Il0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_6' id='gform_target_page_number_6' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_6' id='gform_source_page_number_6' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/div><\/div>\n                        <\/form>\n                        <\/div><script type=\"text\/javascript\">\ngform.initializeOnLoaded( function() {gformInitSpinner( 6, 'https:\/\/natemplaw.co.uk\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_6').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_6');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_6').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! 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