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Equal Opportunity Department (EOD)
Small Employer Complaint Form
Small Employer Complaint Form
If you suspect you have been discriminated against in employment, you can file a complaint below or call the city of Phoenix Equal Opportunity Department at 602-262-7486/voice or 602-534-1557/TTY.
Jurisdictional Elements: Business/employer located within the city of Phoenix boundaries
The employer has 14 or fewer employees
The incident occurred within the past 180 days.
For further information visit: http://phoenix.gov/eod/investigations/discrimination/index.html
I wish to remain anonymous
Contact Information
First Name
*
Primary Phone Number
*
Last Name
*
Secondary 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
Source of Income
Incident Information
Who do you believe discriminated against you?
First Name
*
Last Name
*
Title/Position
*
Where did the alleged act of discrimination occur?
Incident Address
*
City
*
State
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
BN
CA
CO
CT
DC
DE
FC
FL
FM
FR
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PQ
PR
PW
RI
SB
SC
SD
SE
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
ZZ
Zip
*
What is the nature of your complaint?
Age
Color
Disability
Gender
Genetic Info
Marital Status
National Origin
Race
Retaliation
Religious
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?
*
Employer Information
Employer Name
*
Employer Address
*
Unit / Apt
*
City
*
State
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
BN
CA
CO
CT
DC
DE
FC
FL
FM
FR
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PQ
PR
PW
RI
SB
SC
SD
SE
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
ZZ
Zip
*
Number of Employees (Local)
*
*
Number of Employees (Nation)
*
*
Incident Description
*