Pre-Complaint Questionnaire - Employment

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  • The information requested on this form will assist the Office of Equity, Community and Human Rights in helping you. There is no guarantee that the information submitted will result in an investigation. Please check or answer only those questions that apply.
  • Date Format: MM slash DD slash YYYY
  • :
  • I wish to complain against
  • Company, government entity (city, county, state), employment agency, union, etc.
  • Questionnaire

  • Check all appropriate boxes
  • Are you now employed by the employer you believe discriminated against you?
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY