Report Discrimination

What type of employer you believe discriminated against you? *

Business or non-profit organization that I applied to, work or previously worked for

State or Local Government that I applied to, work for or previously worked for

Union that represents me

Temp agency or staffing firm that did not refer me to a job

Federal Government agency that I applied to, work for or worked for as a federal employee or contractor

Other

On what date did the discrimination action occur? *

If you allege more than one discriminatory action, please enter the most recent date.

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I believe I was discriminated against because: *

Check all the apply

Age - I am 40 years of age or older

Color

Disability

Genetic information, my family medical history or my participation in genetic services like counseling, education or testing

National origin and/or ethnicity

Race

Religion

Sex (including pregnancy, sexual orientation and gender identity)

Retaliation - I filed a charge of job discrimination about any of the above

Retaliation - I contacted a government agency to complain about job discrimination

Retaliation - I complained to my employer about job discrimination

Retaliation - I helped or was a witness in someone else;s complaint about job discrimination

Something else

Please enter you year of birth *

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