Employment Enquiry Form

Title Please select... Mr. Mrs. Miss Ms Dr.

Full Name *

Address [address]

Daytime Contact Number *

Mobile Number

Email *

PPS Number

Occupation

Date of Birth

A) If an Employee

Nature of Enquiry Please select... Redundancy Maternity Rights Injury at Work Discrimination Bullying/Harassment Other

Description of Enquiry [enquiry]

Date of Commencement of Employment

Date of Termination of Employment (if applicable)

Reason for Termination of Employment (if applicable) [reason for termination of employment]

B) If an Employer

Nature of Enquiry Please select... Business Start Up Employment Contract Grievance & Disciplinary Redundancy Maternity Rights Injury at Work Discrimination Bullying/Harassment Other

Description of Enquiry [enquiry]