Submitting this complaint questionnaire does not constitute the formal filing of a discrimination charge, but it serves to preserve all rights under the statute of limitations. The formal filing will take place when we review your questionnaire and hold an intake interview with you at the OHR Office.
How do you prefer we contact you?
ARE REPRESENTED BY COUNSEL, PLEASE PROVIDE THE FOLLOWING:
2. Respondent Information
3. Basis of Complaint
Do you feel you were discriminated against because of your:
Please check all that apply:
What action was taken that made you feel you were treated differently:
6. DC Government Employees
Current, former, or prospective DC government employees must first consult a certified agency assigned EEO Counselor within 180 days of the alleged discriminatory act prior to filing with the Office of Human Rights, unless the District Government employee is alleging unlawful discrimination based on sexual harassment or DC FMLA.
You have filed an informal complaint with an agency assigned EEO Officer/Counselor.
Date You First Contacted the EEO Counselor
Date of Exit Letter
If you have received an Exit Letter, please upload.
7. D.C. FAMILY AND MEDICAL LEAVE ACT (For FMLA complaint only)
If you have filed a Family and Medical Leave Act complaint, have you been employed with this company for at least one (1) year and have worked at least one thousand (1,000) hours?
8. WITNESSES:- List who can provide evidence in your support
9. YOUR COMPLAINT:
10. REFERRAL INFORMATION
How did you hear about the DC Office of Human Rights (check all that apply)?