Employment Intake Questionnaire Form

Submitting this complaint questionnaire does not constitute the formal filing of a discrimination charge, but it serves to preserve all rights under the statute of limitations.  The formal filing will take place when we review your questionnaire and hold an intake interview with you at the OHR Office.

1. Complainant Information

IF REPRESENTED BY COUNSEL, PLEASE PROVIDE THE FOLLOWING:

Please note: If you are represented by counsel or retain counsel prior to your scheduled Intake interview, the counsel must either (1) be present with you for the duration of your Intake interview, or (2) withdraw his/her appearance from the interview by submitting a letter to the Office indicating that the interview may take place without his/her representation

2. Respondent Information
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.