These are important instructions when completing your Discrimination Complaint Form. Please read and complete the form as thoroughly as possible. Type or print your complaint. When printing, use INK (for duplicating purposes). DO NOT use pencil. The numbered examples on this document coincide with the numbers on the complaint form. Please be sure to follow the directions.
- First Name, Middle Name and Last Name. For example Mary J. Doe.
- Address. For example, 1234 House Street. City. For example, Columbus. State, For example, OH. Zip, For example 54321.
- Phone Number, For example, 123-456-7890. Please indicate the manner in which you can best be reached. For example, pager, work, cell, home, parent’s or friend’s number.
- Question 4 is the AREA and the BASIS (reason) which you feel caused you to be discriminated against (i.e. race, sex, etc.) Generally, one basis is all you need. If you believe that you need to check more than one, please do so.
- It is very important to include street address, not just a P.O. Box. For example, Mywork, Inc., 1234 Work Place, Columbus, OH 12345-678.
- For example, J.D. Kaeger Enterprises, Inc.; 1509 Briarcliff Court; Columbus, OH 43255-5512.
- To make sure that the Columbus Community Relations Commission has jurisdiction, please be sure to include the number of full and part-time employees working for the company.
- Important, to keep from duplicating efforts of another agency.
- This is one of the most important pieces of information to establish jurisdiction of your complaint.
- Please list dates of negative events pertaining to your claim in chronological order. Please attempt to keep the events to three or four sentences each. See example below.
- On November 1, 1992, I was terminated from my job by J. Smith, Manager, because of my race, black. I believe my race was a factor in being terminated because J. Smith said or did…
- From January 2, 1993 to April 1, 1993, I was sexually harassed by J. Doe, Supervisor… (in the case of harassment if the harasser is a supervisor or in management, then that person should also be named in question #5).
- On May 8, 1993, I tried to get into XYZ Bar. I am black and was charged a $5.00 cover charge. White patrons were admitted without being charged a cover charge.
- On November 5, 1994 I was shopping at ABC Grocery Store. I was harassed by the bagger because I am a homosexual. I believe the bagger was harassing me because of my sexual orientation because he said…
NOTE: Please follow the above examples as much as possible. Remember, that dates are critical for filing your complaint. After your complaint has been filed with the Commission you will be contacted for any additional information that may be needed. If you have any questions or need assistance completing this complaint, telephone the EEO Officer at 614-645-1993.