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Equal Opportunity Department (EOD)
Employee Discrimination Form
Employee Discrimination Form
This form will be for City employee and applicants, alleging discrimination, by City of Phoenix employees. Complaints must be made within 300 days of the last incident. EOD staff will be in contact with you soon to gather additional information.
Contact Information
First Name
*
Mobile Phone Number
*
Last Name
*
Home Phone Number
*
Email Address
*
*
Best Time to Call
Late Morning (9A-11A) (Manana tarde)
Late Afternoon (3P-5P) (Noche Tarde)
Anytime / En Cualquier Momento
Morning / Mañana (6A-11A)
Noon / Mediodía
Afternoon / Tarde (1P-5P)
Evening / Noche (5P-7P)
Night (7P-10P) (Noche)
Alternate Contact
*
Alternate Number
*
Alt Contact Best Time to Call
*
Address Information
Home Address
*
Unit/Apt
*
City
*
State
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Zip
*
If applicable to your complaint of discrimination, what is your:
Race
Alaska Native / Nativo de Alaska
American Indian / Indio Americano
Asian / Asiático
African American / Afroamericano
Black / Negra
Blend / Mezcla
Hispanic / Hispano
Native Hawaiian / Hawaiano Nativo
Other / Otro
Pacific Islander / Isleño Pacífico
Unknown/Unspecified / Desconocido / No Especificado
White (Caucasian) / Blanca (Caucásico)
Religion
Agnostic / Agnóstico
Asatru
Atheism / Ateísmo
Bahai
Buddhism / Budismo
Christianity Cristianismo
Hare Krishna
Hinduism / Hinduismo
Islam
Jehovah's Witness / Testigo de Jehová
Judaism / Judaísmo
Scientology / Iglesia de Scientology
Taoism / Taoísmo
Not Disclosed / No Divulgado
Other / Otro
National Origin
*
Sexual Orientation
Asexual
Bisexual
Heterosexual
Homosexual
Not Identified / No Identificado
Color
*
Gender
Male / Masculino
Female / Femenino
Other / Otro
Marital Status
Single / Soltero
Married / Casado
Divorced / Divorciado
Widowed / Viudo
Complainant
*
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Contract
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Subject
Default Subject
Default Subject
Default Subject
Contract Line
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Origin
In Person
Email
HR
Integrity Line
Mail
Phone
Department Referral
Attorney General
EEOC
Web (Portal)
Facebook
Twitter
IoT
Case Type
Internal
External
Special
Housing Complaint
Public Accommodation Complaint
Small Employer Employment Discrimination Complaint
Employee Discrimination Complaint
Incident Information
Who do you believe discriminated against you?
First Name
*
Last Name
*
Title/Position
*
Department
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What is the nature of your complaint?
Age
Color
Disability
Gender
Genetic Info
Marital Status
National Origin
Race
Religion
Retaliation
Sexual Orientation
If applicable to your complaint of discrimination, what is the persons:
Gender
Male / Masculino
Female / Femenino
Other / Otro
Sexual Orientation
Asexual
Bisexual
Heterosexual
Homosexual
Not Identified / No Identificado
National Origin
*
Race
Alaska Native / Nativo de Alaska
American Indian / Indio Americano
Asian / Asiático
African American / Afroamericano
Black / Negra
Blend / Mezcla
Hispanic / Hispano
Native Hawaiian / Hawaiano Nativo
Other / Otro
Pacific Islander / Isleño Pacífico
Unknown/Unspecified / Desconocido / No Especificado
White (Caucasian) / Blanca (Caucásico)
Marital Status
Single / Soltero
Married / Casado
Divorced / Divorciado
Widowed / Viudo
Color
*
Are there any witnesses?
No
Yes / Sí
Is the alleged Discrimination Ongoing?
No
Yes
When did the last act of Discrimination occur?
*
Incident Description
*
