Best time to call
Today's date:* (mm/dd/yyyy)
If applicable to your complaint of discrimination, what is your:
Number of employees locally:*
Number of employees nationally:*
Please identify potential witnesses by name, title and department. Include address and phone number where known:
What happened to you? Please include dates, witnesses and/or comparative employees who were treated differently. How were you discriminated against?
For example: Were you terminated, not selected for a position, demoted or treated differently in the terms and conditions of your employment?*
Why do you believe you are being discriminated against? It is a violation of the law to discriminate against, or harass in any aspect of employment for the following reasons:
age, genetic information, race, sexual orientation, color, religion, sex, national origin, marital status, disability or gender identity or expression.
Briefly explain why you think your employment rights were denied
because of any of the factors listed above.* Who do you believe discriminated against you? Was it your supervisor, a co-worker or subordinate?
If applicable what is that person's:
Is the alleged discrimination ongoing?
When did the last act of discrimination occur? Enter the date (mm/dd/yyyy)*
Use the submit button below to e-mail your completed form to the intake officer: firstname.lastname@example.org
If you prefer, you may call, mail or fax the completed questionnaire to the Equal Opportunity Department at:
City of Phoenix Equal Opportunity Department
Compliance & Enforcement Division
251 W. Washington St. 7th Floor
Phoenix, AZ 85003
602-262-7486/voice 602-534-1557/TTY 602-495-0517/fax
The Equal Opportunity Department will make every attempt to contact you within 48 hours of receipt of your complaint.
Contact information for employers outside of Phoenix or who have more than 14 employees:
Within 180 days from the most recent alleged discriminatory incident:
Arizona Attorney General's Office, Civil Rights Division,
1275 W. Washington
Phoenix, Arizona 85003
Within 300 days from the most recent alleged discriminatory incident:
U.S. Equal Employment Opportunity Commission, Phoenix District Office 3300 N. Central Ave., Suite 690
Phoenix, Arizona 85012
Before you submit this form, we would like you to be aware of the city's policy on the use of its e-mail systems. The policy states that the e-mail message you are about to send: (1) is subject to public disclosure under the Public Records Law, (2) is not private or confidential and (3) is retained for 90 days.