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Do you work for a private sector employer (not for the District of Columbia government or the federal government)?
Do you spend at least 50 percent of your time physically working in the District of Columbia?
Did the alleged violation(s) occur within the past year?
Superior Court or any other courts?
Have you filed a related complaint with the United States Equal Employment Opportunity Commission (EEOC)?
Do you need reasonable accommodation?
What language do you prefer to communicate in?
Did you apply with the D.C. Department of Employment Services (DOES) for UPL leave? (If you have not applied for UPL leave with DOES, you may apply with DOES to obtain UPL leave.)
Did DOES approve your application for UPL leave?
At the time you sought to obtain paid family or medical leave from your employer, did your employer provide you with any information about UPL, such as eligibility criteria?
Do you allege that your employer interfered with your ability to apply for or take UPL leave?
Were you able to take UPL leave on the days you applied for and/or were approved to take UPL leave?
If yes, what actions did your employer take that you believe were in retaliation against you for taking UPL leave?
Do you allege that your employer retaliate against you for taking UPL leave?
Did you apply for DCFMLA leave with your employer as well as UPL leave?
At the time you sought to obtain family or medical leave from your employer, did your employer provide you with any information about the DCFMLA, such as eligibility criteria?
During these last 12 months you have worked for your employer, did you work at least 1000 total hours?
Do you allege that your employer interfered with your ability to apply for or take DCFMLA leave?
Have you been employed by your employer for at least 12 total months (does not need to be consecutive) over the past 7 years?
Did your employer have at least 20 employees at the time you requested DCFMLA leave?
Had you taken DCFMLA leave in the 24-month period immediately preceding the requested leave?
Did your employer approve your application for DCFMLA leave?
Do you allege that your employer retaliated against you for applying for or taking DCFMLA leave?
I want to file a charge of interference and/or retaliation, and I authorize OHR to investigate the allegations described above
I understand that OHR must give the employer I accuse of the allegations described above information about the charge, including my name
I acknowledge that OHR also will investigate additional claims under other civil rights laws in the District of Columbia, if applicable
I understand that failure to do so may lead to dismissal of my complaint
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