NAME ADDRESS DATE OF BIRTH NI NUMBER TELEPHONE NUMBER(s) EMAIL ADDRESS DATE EMPLOYMENT COMMENCED AT COUNCIL CLOCK or WORKS NUMBER DEPARTMENTS AT COUNCIL WORKED SINCE 1st JANUARY 2011 DATE DEPARTMENT PAY GRADE or BAND APPLICABLE TO EACH OF YOUR JOBS PAY GRADE/BAND JOB TITLE DETAILS OF Are you a Member of a Union ? Yes / No If yes, Union ? Did the Union ever mention the Action to you ? Yes / No Did you speak to anyone at the Union or Yes / No Council about this? If you did, who? Why didn’t you proceed with your own Claim? PLEASE YOUR COMPLETED FORM TO :
NAME ADDRESS DATE OF BIRTH NI NUMBER TELEPHONE NUMBER(s) EMAIL ADDRESS DATE EMPLOYMENT COMMENCED AT COUNCIL CLOCK or WORKS NUMBER DEPARTMENTS AT COUNCIL WORKED SINCE 1st JANUARY 2011 DATE DEPARTMENT PAY GRADE or BAND APPLICABLE TO EACH OF YOUR JOBS PAY GRADE/BAND JOB TITLE DETAILS OF Are you a Member of a Union ? Yes / No If yes, Union ? Did the Union ever mention the Action to you ? Yes / No Did you speak to anyone at the Union or Council about this? If you did, who? Yes / No Why didn’t you proceed with your own Claim? PLEASE YOUR COMPLETED FORM TO :
NEW-COUNCIL-EMPLOYEE-FORM.docx