Claim Form Test 1Employee details2Step 1: Questionnaire3Step 2: Build evidence Let’s check if you have a work claim using our eligibility questionnaire. Step 1 will take about 5 minutes and it will identify if you are eligible to make an unfair dismissal, general protections or workplace bullying application. You can save and return to it at any time. Before we can start we need some information from you:Title*MsMrsMissMrDrProfFirst name(s)* Surname* Postal address* Street Address Suburb State Post Code Best contact number*Email address* Age* Name of your employer* Industry* * I accept Resolution123’s collection notice I accept that the information provided by Resolution123 is not legal advice and is not a substitute for legal advice. I acknowledge I can attain legal advice by submitting my brief to a lawyer and partnering with that lawyer to resolve my claim Hidden I would like to join the Resolution123 mailing list to receive employment law updates and related news. Are you an employee? Yes No If you are an employee your employer will usually: determine how, when and where you perform your work; be responsible for your work and supply the tools and equipment you need; and provide leave entitlements, pay you wages or salary, pay superannuation and deduct payroll tax, if this describes you answer yes, if not you may be an independent contractor and should answer no. Are you an independent contractor? Yes No If you are an independent contractor you will usually: control how, when and what work is done; have your own business and invoice for payment; have responsibility for the work and be liable for that work if something goes wrong; have your own insurances and pay your own superannuation and taxes; use your own tools and equipment; not be entitled to paid leave, if this describes you answer yes. Is your employer or principal any of the following?Select OptionPrivate BusinessThe Federal GovernmentA Commonwealth AuthorityA Body Corporate Incorporated in a Territory or conducted principally in a Territory or Commonwealth PlaceNot sureDid your employer or principal take adverse action against you because you have a workplace right? Yes No There must be a link between your workplace right and the adverse action you say your employer/ principal has taken against you. Some examples of workplace rights include: the right to have an award or enterprise agreement apply to you; the right to leave entitlements such as personal/carer’s leave; your parental leave and associated rights e.g. the right to return to your pre-parental leave position and to be consulted about any changes to your pre-parental leave position; the right to perform a representative function for example as a grievance officer or health and safety officer; the right to request flexible working arrangements; the right to participate in proceedings before the Fair Work Commission; the right to make a complaint or enquiry in relation to your employment e.g. checking your pay is correct; and the right to make a complaint or enquiry to the Fair Work Ombudsman or the work, health and safety regulator. Some examples of adverse action include: dismissal including forced resignation or demotion; not providing entitlements; treating you differently to others; refusing to hire you. What workplace right applies?Select Optionthe right to have an award or enterprise agreement apply to you;the right to leave entitlements such as personal/carer’s leave;your parental leave and associated rights e.g. the right to return to your pre-parental leave position and to be consulted about any changes to your pre-parental leave position;the right to perform a representative function for example as a grievance officer or health and safety officer;the right to request flexible working arrangements;the right to participate in proceedings before the Fair Work Commission;the right to make a complaint or enquiry in relation to your employment e.g. checking your pay is correct;the right to make a complaint or enquiry to the Fair Work Ombudsman or the work, health and safety regulator;othernot sureWhat adverse action did your employer or principal take?Select Optiondismissal including forced resignation or demotion;not providing entitlements;treating you differently to others;refusing to hire you;othernot sureHiddenAre you currently on or have you recently returned from parental leave? Yes No Have you made a request to extend your parental leave that has been declined by your employer? Yes No Did you resign or are you considering resigning due to your request for additional parental leave being declined? Yes No Can you tell us specifically if you resigned or are considering resigning?*Select OptionI have resignedI am considering resigningHave you experienced any change in status, pay or location to your pre-parental leave position? Yes No Did your employer give you information about, and an opportunity to discuss, any change to the status, pay or location of your pre-parental leave position? Yes No Did your employer offer you an available position that you are qualified for and suited to, and that does not have a reduction in pay or duties? Yes No Did you resign or are you considering resigning due to the changes to your pre-parental leave position? Yes No Can you tell us specifically if you resigned or are considering resigning?Select OptionI have resignedI am considering resigningHave you recently made a request for flexible working arrangements that was refused by your employer? Yes No Why did you make the request for flexible working arrangements?Select OptionI have responsibility for the care of a child school age or youngerI am a carerI have a disabilityI am 55 or olderDo you feel you feel you have been discriminated against because you made the request for flexible work? Yes No Did you resign or are you considering resigning due to your request for flexible work being refused? Yes No Can you tell us specifically if you resigned or are considering resigning?Select OptionI have resignedI am considering resigningDid your employer discriminate against you because of your race, colour, sex, sexual orientation, age, physical or mental disability, marital status, family or carer's responsibilities, pregnancy, religion, political opinion, national extraction or social origin? Yes No On what basis do you say your employer discriminated against you:Select OptionRaceColourSexSexual OrientationAgePhysical or Mental DisabilityMarital StatusFamily or Carer's ResponsibilitiesPregnancyReligionPolitical OpinionNational ExtractionSocial OriginDid your employer dismiss you because you were absent from work because of illness or injury? Yes No Did your absence for illness or injury extend for more than 3 months or more than 3 months collectively over a 12 month period? Yes No Are you experiencing bullying at work? Yes No A worker is bullied at work if: an individual or group repeatedly behaves unreasonably towards the worker; and that behaviour creates a risk to health and safety; and the behaviour is continuing. Reasonable management action is not workplace bullying if it is carried out in a reasonable way, for example, implementing a performance management plan to improve workplace performance.Have you been dismissed? Yes No You have been dismissed if your employer has terminated your employment or you resigned but were forced to because of conduct by your employer. Demotion will also amount to dismissal if the demotion involves a significant reduction in remuneration or duties. Answer yes if your employer has made you redundant. Answer yes if you are still working for your employer but you have been given notice of termination of employment.How were you dismissed?Select Optionmy employer dismissed me (includes redundancy and where you have been given notice but are still working);I was forced to resign because of conduct by my employer;my employer demoted meWere you dismissed in the last 21 calendar days? Yes No HiddenHave you been demoted? Yes No Does the demotion involve a reduction in your remuneration and/or your duties? Yes No Was your employer either a private business or the federal government? Yes No Did your employer have 15 or more employees at the time of your dismissal (excluding casuals who are not engaged on a regular and systematic basis, including employees of associated entities)? Yes No Have you been employed for at least 6 months? Yes No Have you been employed for at least 12 months? Yes No Were you a casual employee? Yes No Were you engaged on a regular basis and did you expect your employment to continue? Yes No Does an award or enterprise agreement cover your employment? Yes No Not sure Do you earn less than $142,000 per annum (excluding compulsory superannuation contributions)? Yes No Was your job made redundant? Yes No Is your job still required to be performed by anyone? Yes No Did your employer consult with you about the redundancy? Yes No Did your employer attempt to redeploy/move you to another job with it or any associated entity? Yes No Based on the answers you have given, you may have an unfair dismissal claim. To prove your claim we need to build your case with evidence, let's start step 2 together.Landed on Q23? Based on the answers you have given, you may have a general protections claim. To prove your claim we need to build your case with evidence, let's start step 2 together.Based on the answers you have given, you may be able to make an application for an order to stop the bullying. To prove your claim we need to build your case with evidence, let's start step 2 together.You'll need to submit your enquiry to a lawyer. Did your employer dismiss you for any of the following reasons:* Yes No stealing money or goods from the business; defrauding the business; threatening the employer or other employees, or clients, with violence, or actually carried out violence in the workplace; a serious breach of occupational health and safety procedures. Which reason for dismissal was given?*Select Optionstealing money or goods from the business;defrauding the business;threatening the employer or other employees, or clients, with violence, or actually carried out violence in the workplace;a serious breach of occupational health and safety procedures.Did your employer dismiss you for some other form of serious misconduct?* Yes No What was the reason?* Did your employer dismiss you because of unsatisfactory conduct, performance or capacity to do the job?* Yes No Did your employer warn you (either verbally or in writing) that you were not doing the job properly and would have to improve your conduct or performance, or otherwise be dismissed?* Yes No Did your employer provide you with a reasonable amount of time to improve your performance or conduct? Yes No How much time was given?* Did your employer offer to provide you with any training or opportunity to develop your skills?* Yes No Did you subsequently improve your performance or conduct?* Yes No Before you were dismissed did your employer tell you the reason for the dismissal and give you an opportunity to respond?* Yes No Please attach any supporting documentation e.g. warning letters, notes from meetings.* Drop files here or Select files Max. file size: 128 MB. Did your employer dismiss you for some other reason?* Yes No What was the reason?* In any discussion with you where dismissal was possible, did you request to have a support person present?* Yes No Did the employer agree to that request?* Yes No What was the name of your support person?* What is your relationship to the support person?* Did you resign from your employment because of conduct by your employer?* Yes No What was the conduct that caused your resignation?* Please attach any supporting documentation including your resignation if it was in writing and any response you received from your employer. Drop files here or Select files Max. file size: 32 MB. Why do you believe the dismissal was unfair?*What date did you begin working for the employer or principal? (DDMMYYYY)* Upload your employment contract or independent contractor agreement and any variations to it Drop files here or Select files Max. file size: 32 MB. Upload your last two payslips including your termination payslip Drop files here or Select files Max. file size: 128 MB. On what date were you notified of the proposed redundancy? (DDMMYYYY)* Upload the notice of redundancy Drop files here or Select files Max. file size: 32 MB. On what date were you given notice of your dismissal? (DDMMYYY) Please upload the notice of dismissal letter Drop files here or Select files Max. file size: 32 MB. What date did your dismissal take effect? (DDMMYYYY) Please note: your claim must be filed within 21 calendar days of dismissal.On what date/s did your employer or principal take adverse action against you?(DDMMYYYY) Describe the actions of your employer that you believe are unlawfulUpload any evidence of the adverse action such as notes, emails or letters Drop files here or Select files Max. file size: 32 MB. On what date/s did your employer discriminate against you?(DDMMYYYY) Describe the actions of your employer that you believe are unlawfulPlease upload any evidence of the discrimination such as notes, emails or letters Drop files here or Select files Max. file size: 32 MB. Insert the start and end date for each absence for illness or injury in the past 12 monthsStart date (DDMMYYYY)End date (DDMMYYYY) Please upload all relevant medical certificates or statutory declarations Drop files here or Select files Max. file size: 32 MB. Insert the start date of the bullying conduct and outline the bullying behaviour including who, when and how the bullying has occurredHave you raised your complaint with your employer? Yes No Describe how your complaint has been dealt with to dateUpload any relevant policies of your employer/principal regarding workplace bullying and complaint handling Drop files here or Select files Max. file size: 32 MB. CAPTCHA Δ