| |
This is a form to use for general discrimination complaints, including employment discrimination. Use this other form for housing discrimination complaints. Completing this form does not constitute filing an official complaint with a legal authority. At this time, the Texas NAACP is only seeking information to assist you concerning this complaint.
|
|
Fill this form out on line by typing in the boxes, selecting the proper circles with the mouse, and using the tab key or mouse to move from box to box (do not use the Enter/Return button). Don't worry if text you enter scrolls out of sight, we will still get all of it. Submit the finished form electronically.
|
|
First Name: |
|
|
|
Last Name: |
|
|
|
Email Address: |
|
|
|
|
|
|
|
Street Address: |
|
|
City/State/Zip: |
|
|
|
|
Was the discrimination because of (Please check all that apply) |
|
|
|
Who discriminated against you? Give name and address of the employer, labor organization, employment agency, etc. |
|
|
|
Have you filed a grievance with any governmental agency(ies)? If yes, which one(s)? |
|
|
|
|
Have you retained an attorney regarding this case? |
|
|
|
Equal Employment Opportunity Commission - EEOC Name of Local Representative: |
|
|
|
Have you retained an attorney regarding this case? |
|
|
|
Attorneys address: |
|
|
Attorneys Phone: |
|
|
The actual date or the most recent date on which this discrimination occurred: |
|
|
|
Tell us as much as you can. For example: were you fired? Did you fail to get a promotion? Did the company refuse to hire you? Did the union or employment agency refuse to refer you to a job? Who discriminated against you? Why do you believe it was because of your race, color, religion, national origin, sex, age, or other? |
|
|
|
Type your name and today's date and submit this form electronically: |
|
|
|
|
|
|
|
|
|