Ealing Advice Enquiry form Please complete the form so we can work out how best to help you with your question. Enquiry Form Name*House number / Street*Postcode*Email* Phone*I am contacting you about:*Select your optionEmploymentHousingBenefitsDebtEmploymentPlease select an option:Select oneUnfair dismissalDiscriminationSettlement agreementHow many years have you worked?*Less than 2 yearsMore than 2 yearsHave you been dismissed?*YesNoDate of dismissal* Date Format: DD slash MM slash YYYY Please state reason given for dismissal*Did you appeal against the decision?*YesNoHave you applied to ACAS /ET?*YesNoHave you started the grievance procedure?*YesNoDownload the grievance procedure form here Brief summary of caseAre you claiming constructive dismissal?*YesNoHave you used you grievance procedure?*YesNoHave you left?*YesNoDate of leaving* Date Format: DD slash MM slash YYYY Brief summary of caseWhich grounds have you been discriminated on?* Sex Race Disability Religion Other Please give more detail*Legal advice on what to do if your employer asks you to take early retirement Are you complaining of harassment?*YesNoYou might find this link useful. Brief summary of caseAre you looking to come to a settlement with your employer?*YesNoHave they agreed to consider it?*YesNoHave they agreed to fund independent legal advice?*YesNoWe could help - would you like to book an appointment?*YesNoClick here to book an appointment Here is some information on rights to legal fees and getting independent advice Why do you want them to consider one?*Brief summary of caseHousingPlease select an option:*Rent / possessionHomelessnessHow much do you owe?*Less than 1 week's rentMore than 2 month's rentMore than 3 month's rentHave you claimed help with rent?*Yes as a part of UCYes from Housing benefitYes - refused helpNoHave you tried to claim extra help from LWA?*YesNoWhat was the outcome?*Action by your landlordLetterNoticeApplied to courtObtained orderObtained a bailiffDate served* Date Format: MM slash DD slash YYYY Date effective* Date Format: MM slash DD slash YYYY Court date* Date Format: MM slash DD slash YYYY Please choose an option:AjournedSuspendedOutrightDate served* Date Format: MM slash DD slash YYYY Brief summary of case*Are you still in your property?*YesNoHave you applied to the council for help?*YesNoHave they accepted your application?*YesNoWhat is wrong with your housing?*Date of decision* Date Format: MM slash DD slash YYYY Have they "discharged" ( cancelled) their duty?*YesNoDate of decision* Date Format: MM slash DD slash YYYY Brief summary of case*BenefitsDo you want help with applying for benefit?YesNoHave you checked on an on online calculator?*YesNoHave you checked on the government's website? Go to turn2us - it will allow you to work out what you could claim Brief summary of your caseDo you want help with challenging a benefit refusal?*YesNoHave you had a decision?*YesNoDate of decision* Date Format: MM slash DD slash YYYY Have you have asked for a mandatory reconsideration?*YesNoHave you had a decision?*YesNoDate of decision Date Format: MM slash DD slash YYYY If you disagree with it, have you asked for an appeal?*YesNoBrief summary of your caseDebtDo you have a debt issue?*YesNoDo you agree that you owe the money?*YesNoDo you have more than one debt?*Please check all that apply Rent Council tax Tax / Tax credits Utilities (gas / electricity / water) Credit card Other Please describe*What action has been taken?*Please check all that apply Letters Frozen account Debt collector letters Court actions Threatened court action Started bailiffs Sent letters bailiff enforcement Attachment of earning / benefits Do you need more information on options?YesNoLink for more information. Have you completed an income expediture sheet in the last 3 months?YesNoPlease send it if you canAccepted file types: doc, docx, pdf, txt, jpg, gif.You can download an income /expenditure sheet here (PDF) Please update this and send itAccepted file types: doc, docx, pdf, txt, jpg, gif.Website CommentsThis field is for validation purposes and should be left unchanged.