Wrongful Termination Assessment Questionnaire
Please answer the following questions accurately so we can assess your termination, entitlements, constructive dismissal, and any potential reprisal or bad faith concerns.
Name
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
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Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
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Belarus
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Benin
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Botswana
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Burkina Faso
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Cameroon
Canada
Cape Verde
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China
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Cote d'Ivoire
Croatia
Cuba
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Cyprus
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Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
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Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Part 1: The Nature of the Termination
Determine whether you were terminated or resigned, whether a reason was provided, and whether the termination was with or without cause. If you resigned, continue to Part 3.
Were you officially terminated, or did you resign?
*
Terminated
Resigned
Not sure
Did your employer provide a written reason for your termination?
*
Yes
No
Not sure
Was your termination with cause or without cause?
*
With cause
Without cause
Not sure
If you were terminated with cause, did you receive any prior written warnings or progressive discipline?
Yes
No
Not sure
Part 2: Entitlements and Notice (Common Law vs. ESA)
Assess whether the severance or termination package appears to meet a reasonable notice standard and gather the details needed to evaluate notice and entitlements.
How long were you employed with the company?
*
What was your job title and primary responsibilities?
*
How old are you?
*
What was included in your final termination or severance offer?
Did you sign a release or severance agreement?
*
Yes
No
Not sure
If yes, how long ago did you sign it?
Part 3: Constructive Dismissal (If you resigned)
Use this section to determine whether a major unilateral change or a toxic environment may have forced you to resign.
Did your employer make a major, unilateral change to your job without your consent?
*
Yes
No
Not sure
Did you clearly object to these changes in writing before resigning?
*
Yes
No
Not sure
Did you resign specifically because of these changes or a toxic or harassing work environment?
*
Yes
No
Not sure
Part 4: Retaliation and Bad Faith
Identify whether the termination may have been a reprisal and whether there is a written employment contract that could affect the analysis.
Did the termination happen shortly after you complained about harassment or safety, requested a medical or parental leave, or requested a disability accommodation?
*
Yes
No
Not sure
Do you have a written employment contract?
*
Yes
No
Not sure
Please upload your termination letter if available
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Free Assessment Tips
The 2-Year Rule: Members generally have two years from the date of termination to file a claim in court.
Documentation: Gather your Employment Contract, Termination Letter, and Pay Stubs for the assessment.
Mitigation: Keep records of your active job search after being fired.
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