Randy Ai Law Office

What is the full legal name of your employer? If you don’t know the full legal name of your employer, you can find it by looking at your most recent T4 Tax Statement, or by looking at your termination letter.

We will be sending a legal letter on your behalf. Who do you want us to send the letter to? Please provide us with the full name (first name and last name) of the person or persons you want us to send the letter to. The person could be a supervisor, manager, human resources representative, owner/CEO of the company etc.

Please provide us with the email address or email addresses of the person(s) that the legal letter is being sent to.

On what date did you first start working for your employer? If you don’t remember the exact date, please provide an approximate date. If there are several possible dates, use the earliest date for the purposes of this question.

On what date were you terminated? If you were given working notice by your employer, use the date of your termination letter not your employment end date. If you don’t know the exact date of your termination, use an approximate date.

What is your most recent job title?

What is your current age?

What is your annual base salary? ($)

Are you entitled to an annual bonus? (Yes/No)

What is your annual bonus? Please express it as a dollar figure. If your bonus fluctuates, please provide an approximate annual amount. You may round up. ($)

Are you entitled to commissions? (Yes/No)

What are your annual commission earnings? Please express it as a dollar figure. If your commission earnings fluctuate, please provide an approximate annual amount. You may round up. ($)

Are you entitled to group insurance benefits? For example health, dental, disability benefits etc. (Yes/No)

What is the approximate monetary value of your group insurance benefits? If you don’t know or you have not been provided with this information by your employer, please enter $5,000 (which is the average cost of benefits in Canada). ($)

Are you entitled to a health spending account? A health spending account is a fixed amount of money that the employer sets aside for you each year for health expenditures. (Yes/No)

What is the annual monetary value of your health spending account? ($)

Are you entitled to a pension plan? (Yes/No)

What is the approximate annual employer contribution to your pension plan? An estimate is sufficient. ($)

Are you entitled to employer RRSP matching and/or employer RRSP contributions? (Yes/No)

What is the annual employer contribution towards your RRSP? ($)

Are you entitled to equity and/or restricted share units? (Yes/No)

What is the annual monetary value of your equity entitlements and/or restricted share units? In other words, if you were to express this entitlement as part of your annual compensation, what would be the yearly dollar figure associated with this entitlement (approximately)? ($)

What is the total approximate value of all outstanding equity entitlements and/or restricted share units, inclusive of all shares that are currently unvested? ($)

Are you entitled to a car allowance? (Yes/No)

What is the annual monetary value of your car allowance? ($)

Does the employer pay for your cell phone plan (Yes/No)

What is the approximate annual cost of your cell phone plan? ($)

Does the employer provide you with paid memberships? For example, gym memberships etc. (Yes/No)

What is the annual monetary value of employer-sponsored membership fees? ($)

Are you entitled to any other form of compensation not previously mentioned? (Yes/No)

What other form of compensation are you entitled to?

What is the annual value of this entitlement? ($)

How many weeks of paid vacation are you entitled to?

How many paid sick days and/or personal days are you entitled to per year? (If any)

Does the employer owe you any unpaid compensation? For example, unpaid wages, unpaid commissions, or unpaid bonuses? (Yes/No)

How much does the employer owe you? ($)

Did your employer induce/recruit you to leave a previous place of employment in order to join them? For example, you were actively recruited AND you left your previous job in order to work for your employer. (Yes/No)

What company/organization were you working for when you were induced/recruited by your employer?

For how many years were you working for the previous company/organization?

Did you experience discrimination in the workplace? In other words, were you treated unfairly because of your age, disability, gender, race, religion etc? (Yes/No)

What type of discrimination did you experience? Check all that apply

Please explain how the employer discriminated against you and/or who discriminated against you. (Maximum 250 words).

Did you experience harassment, bullying, verbal abuse, sexual harassment, or violence in the workplace? (Yes/No)

Please explain who in the workplace harassed and/or bullied you, and what happened. (Maximum 250 words)

While you were employed, did you uncover that your employer was engaging in fraudulent or illegal activity? (Yes/No)

Please explain what the employer was doing and/or whether you were terminated in reprisal for whistleblowing. (Maximum 250 words)

Has the termination had a negative impact on your life? (Yes/No)

Please explain the negative effects of the termination on your life, health, mental health, financial situation, family situation, etc. (Maximum 250 words)

Are you currently unemployed? (Yes/No)

Thank you for completing this questionnaire!

Your information has been received, and the lawyer responsible for your file will get back to you soon.

Confidential Questionnaire

What is your first name?

What is your last name/surname?

What is your preferred salutation?

What is the full legal name of your employer? If you don’t know the full legal name of your employer, you can find it by looking at your most recent T4 Tax Statement, or by looking at your termination letter.

Please provide us with the email address or email addresses of the person(s) that the legal letter is being sent to.

On what date did you first start working for your employer? If you don’t remember the exact date, please provide an approximate date. If there are several possible dates, use the earliest date for the purposes of this question.

On what date were you terminated? If you were given working notice by your employer, use the date of your termination letter not your employment end date. If you don’t know the exact date of your termination, use an approximate date.

What is your most recent job title?

What is your current age?

What is your annual base salary? ($)

Are you entitled to an annual bonus? (Yes/No)

What is your annual bonus? Please express it as a dollar figure. If your bonus fluctuates, please provide an approximate annual amount. You may round up. ($)

Are you entitled to commissions? (Yes/No)

What are your annual commission earnings? Please express it as a dollar figure. If your commission earnings fluctuate, please provide an approximate annual amount. You may round up. ($)

Are you entitled to group insurance benefits? For example health, dental, disability benefits etc. (Yes/No)

What is the approximate monetary value of your group insurance benefits? If you don’t know or you have not been provided with this information by your employer, please enter $5,000 (which is the average cost of benefits in Canada). ($)

Are you entitled to a health spending account? A health spending account is a fixed amount of money that the employer sets aside for you each year for health expenditures. (Yes/No)

What is the annual monetary value of your health spending account? ($)

Are you entitled to a pension plan? (Yes/No)

What is the approximate annual employer contribution to your pension plan? An estimate is sufficient. ($)

Are you entitled to employer RRSP matching and/or employer RRSP contributions? (Yes/No)

What is the annual employer contribution towards your RRSP? ($)

Are you entitled to equity and/or restricted share units? (Yes/No)

What is the annual monetary value of your equity entitlements and/or restricted share units? In other words, if you were to express this entitlement as part of your annual compensation, what would be the yearly dollar figure associated with this entitlement (approximately)? ($)

What is the total approximate value of all outstanding equity entitlements and/or restricted share units, inclusive of all shares that are currently unvested? ($)

Are you entitled to a car allowance? (Yes/No)

What is the annual monetary value of your car allowance? ($)

Does the employer pay for your cell phone plan (Yes/No)

What is the approximate annual cost of your cell phone plan? ($)

Does the employer provide you with paid memberships? For example, gym memberships etc. (Yes/No)

What is the annual monetary value of employer-sponsored membership fees? ($)

Are you entitled to any other form of compensation not previously mentioned? (Yes/No)

What other form of compensation are you entitled to?

What is the annual value of this entitlement? ($)

How many weeks of paid vacation are you entitled to?

How many paid sick days and/or personal days are you entitled to per year? (If any)

Does the employer owe you any unpaid compensation? For example, unpaid wages, unpaid commissions, or unpaid bonuses? (Yes/No)

How much does the employer owe you? ($)

Did your employer induce/recruit you to leave a previous place of employment in order to join them? For example, you were actively recruited AND you left your previous job in order to work for your employer. (Yes/No)

What company/organization were you working for when you were induced/recruited by your employer?

For how many years were you working for the previous company/organization?

Did you experience discrimination in the workplace? In other words, were you treated unfairly because of your age, disability, gender, race, religion etc? (Yes/No)

What type of discrimination did you experience? Check all that apply

Please explain how the employer discriminated against you and/or who discriminated against you. (Maximum 250 words).

Did you experience harassment, bullying, verbal abuse, sexual harassment, or violence in the workplace? (Yes/No)

Please explain who in the workplace harassed and/or bullied you, and what happened. (Maximum 250 words)

While you were employed, did you uncover that your employer was engaging in fraudulent or illegal activity? (Yes/No)

Please explain what the employer was doing and/or whether you were terminated in reprisal for whistleblowing. (Maximum 250 words)

Has the termination had a negative impact on your life? (Yes/No)

Please explain the negative effects of the termination on your life, health, mental health, financial situation, family situation, etc. (Maximum 250 words)

Are you currently unemployed? (Yes/No)

Thank you for completing this questionnaire!