Last updated on Feb 17, 2026
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COMPLAINT FORM Name in full complainant please print Street City State Zip Code Home Phone No. Department Position/Title Work Phone No. Select your classification Executive Staff Supervisor/Manager Sex Religion Sexual Harassment Age National Origin Retaliation Handicap/Disability Other The alleged discrimination occurred in connection with check all that apply Interview Nature of alleged discrimination Race Support Staff Hiring Selection Termination Name s Title s Department s and Telephone...Number s of Person s who you believe discriminated against you Name Telephone Number Use additional sheets if necessary Date on which incident s occurred Location of incident s Name s of witness es Please supply any supporting evidence to document the basis for the alleged discrimination you are claiming as indicated in your response to numbers 5 and 6 of this form. I have attached supporting documents Yes No If yes describe attachments Describe the alleged discrimination you and/or others were...subject to Qualifications for position/placement sought or why dismissal was not justified What action s do you feel are necessary to remedy the alleged discrimination List those persons with whom you have discussed the incident s Have you filed a complaint outside of the company Yes No If yes please list entity or attorney handling your complaint. Include all contact information Address Phone Number Have you tried to resolve this issue through your supervisor s and/or the company s grievance...procedure Yes If yes please explain I understand the following I affirm that I have read the above information and that it is true and correct to the best of my knowledge. state and/or federal agency or file suit in a court of law. Signature of Complainant Human Resources Representative Date Complainant is not required to sign this form* Note to Human Resources Representative If complainant does not want to sign this form ask him/her to verify the information and correct any of the information...that is not correct.
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What is discrimination
Discrimination is the unjust or prejudicial treatment of different categories of people, often based on characteristics such as race, gender, age, or disability.
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Explore how professionals across industries use pdfFiller.
Discrimination employee company form is needed by:
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Employers looking for hiring policies.
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Organizations aiming to promote equality.
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Activists and advocates fighting against injustice.
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Researchers studying social behavior.
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Legislators drafting anti-discrimination laws.
Ultimate Guide to Filling Out the Discrimination Complaint Form
How does the discrimination complaint process work?
Understanding the discrimination complaint process is crucial for anyone who believes they have faced discrimination. Discrimination is defined by various federal and state laws, which may include protections based on race, gender, age, and disability, among others. The complaint process serves as an essential step for victims to assert their rights and seek justice.
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Discrimination refers to unfair treatment based on protected characteristics. It violates established laws meant to promote equal opportunity.
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Filing a complaint is often the first step in holding employers accountable and laying the groundwork for resolution.
What are the step-by-step instructions for completing the discrimination complaint form?
Completing the discrimination complaint form accurately is vital to your case. Start with filling out your personal information, including your name, address, and contact number. Be sure to identify your job classification, whether you are part of the executive team or support staff.
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Include all relevant personal details for contact purposes, which ensures that authorities can follow up as needed.
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Clearly articulate the nature of the alleged discrimination, along with pertinent dates and locations.
Who should you name in your discrimination complaint?
Identifying individuals involved in your discrimination complaint is crucial for building your case. You'll want to provide names and contact details for both the individuals who allegedly discriminated against you and any witnesses who can corroborate your account.
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List out anyone who you believe was involved in the discriminatory actions.
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Include contact information for any witnesses who can support your claims and provide statements.
What evidence should you collect to support your claim?
The right evidence is foundational to substantiating your discrimination claim. Start by collecting supporting documents such as emails, voice recordings, and witness testimonies. Documenting these instances thoroughly could elevate the legitimacy of your case.
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Include various types of evidence, as these will strengthen your claim.
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Mention whether you've attached supporting documents directly to your complaint.
What actions can you take after the incident?
After experiencing discrimination, several remedies may be available. Engage with internal grievance procedures within your company, or if necessary, elevate your complaint to external agencies such as the Equal Employment Opportunity Commission (EEOC). Taking these steps can help create a pathway to resolution.
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Start by utilizing the internal grievance procedures provided by your employer.
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Consider taking your complaint to external agencies for legal recourse.
How do you file a complaint outside your company?
Knowing when and how to file an external complaint can significantly impact your case. Identify appropriate agencies, like the EEOC, to handle your claim and ensure you include all necessary contact information for future correspondence.
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Understand which external entities are relevant for filing your claim.
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Know the next steps if you've already initiated an external complaint.
How do you finalize your complaint form submission?
Before submitting your form, a thorough review is essential. Ensure that all information is accurate and complete. Understanding your rights after the submission can empower you in the following steps.
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Double-check all entries to avoid any errors that could impede your complaint.
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Familiarize yourself with what to expect after submission, including potential timelines.
How can pdfFiller assist in managing your complaint form?
pdfFiller’s document management tools can streamline the process of filling out and submitting your discrimination form. Features like eSignature capabilities enable a seamless signing process, while collaboration tools allow for teamwork in addressing your complaint if necessary.
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These allow you to sign documents conveniently and ensure everything is in order.
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Involve team members in the process, making it easier to compile all necessary information.
How to fill out the discrimination employee company form
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1.Open the PDF document meant for filling out discrimination details.
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2.Read the introductory section carefully to understand the purpose of the document.
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3.Locate the personal information section and fill in your name, address, and contact details accurately.
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4.Proceed to the discrimination details section; describe the nature of the discrimination experienced.
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5.In the next fields, provide any relevant dates, locations, and names of individuals involved.
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6.Attach any supporting documentation or evidence, such as photographs or witness statements, if applicable.
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7.Review the completed document for accuracy and completeness before submission.
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8.Save the document in the desired format or print it for your records.
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