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Fair Credit in Employment Intake Form

Employment Intake Questionnaire
Credit Information

The new Fair Credit in Employment Act of 2016 prohibits employers in the District of Columbia from asking for or relying on the credit information of a current or potential employee in making employment decisions (exceptions apply). Credit Information is a new protected trait in the workplace under the DC Human Rights Act of 1977 and is defined as “any written, oral, or other communication of information bearing on an employee’s credit worthiness , credit standing, credit capacity, or credit history.” For more information call the Office of Human Rights or visit Fields with asterisks (*) are required.  


To file a complaint, the alleged violation must meet the following criteria (please check the required boxes):

Complainant Information

Do you need a reasonable accommodation?

What language do you prefer to communicate in? *

Do you require a language interpreter?

Incident Information

Attorney or Counsel Information (optional)

Counsel Address

Incident Information

The following steps help us to ensure we have the proper information about your housing application experience and assists us in preparing for our intake interview with you. Please complete each step below to the best of your ability before submitting this complaint to us (required boxes are marked with **).

Has your employer required, requested, suggested or caused you to submit credit information at any point in your employment?

Do the duties in this position involve MPD/law enforcement or a financial institution? *

Does this position require a security clearance?

Step 2: Witnesses

Do you know of individuals who can speak to your experience and provide evidence in your support?

Step 3: Other Factors

There may be other factors that you believe are involved in you being treated differently. Please check any additional factors you believe may have influenced your employer to treat you differently:

DC Government Employees or Applicants Only

DC government employees must consult an agency EEO counselor within 180 days of the alleged discriminatory act prior to filing with OHR, unless the employee is alleging sexual harassment. OHR cannot process a complaint from a current or former DC Government employee unless (1) the employee has received an exit letter from an agency EEO Counselor; (2) 21 days have passed since the matter was called to attention of the agency’s EEO Counselor and no exit letter has been written; or (3) the employee is alleging sexual harassment.

You have filed an informal complaint with an agency assigned EEO Officer/Counselor

Date Filed

Date Picker

Date of Exit Letter:

Date Picker

Additional Narrative Information


I want to file a charge of discrimination, and I authorize OHR to look into the discrimination I described above. I understand the agency must give the employer, union, or employment agency that I accuse of discrimination information about the charge, including my name. I acknowledge OHR will also investigate additional claims using other civil rights laws in the District ofColumbia.


Date Picker
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