EPAS questionnaire

First name *

Surname *

Email address *

Telephone number *

How much do you earn? *

£0 - £10K

£10K - £20K

£20K - £30K

£30K - £40K

£40k +

We review all applications on a case-by-case basis. If your salary is over £40k, please briefly state your actual salary and the reasons for requesting financial assistance in the box provided below.

Salary over £40k

Do you believe you are experiencing or have experienced unequal pay? *

Yes

No

Not sure

Are you still in work? *

Please specify

If you no longer work for the employer who you believe discriminated against you, please advise of the date your employment ended? *

Day

Month

Year

Are you in a trade union? *

Yes

No

Don't know

If yes, which one?

How did you hear about the Equal Pay Fund? *

If other please provide further information.

You can read Leigh Day's privacy policy. There you will find information on what rights you have, how to act on them, and on what basis and how we process your data.

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