Equal Employment Opportunity/Affirmative Action Office

Online Complaint Form

 
 

Name:
Home phone with area code:
Mailing Address:

Work location:		Work Telephone:
Division:		Position:
Facility:		Work hours:
Work Site:		Immediate Supervisor:

 
 

Type of Complaint:		Basis of Charge: Race National Origin Sex Age Creed Handicap Religion Color
	Discrimination
	Workplace Harrassment
	Retaliation
	Other (please specify)

Dates discrimination took place:
Earliest:		Latest:		Continuing?	Yes	No
Description of charges - Must provide a narrative description of the complaint including what happened, dates(s) of alleged incidents(s), the harrasser(s) or respondents(s) and witnesses.

 

EEO Home Page

Last Modified: 3/5/03