Complaint Form

Welcome to EOD Discrimination Complaint System

Last Name: * First Name: * Middle Initial:
*
Primary phone:
Alternate phone:
Home Address: *
City: *
State:
select
*
Zip code: *
Are you presently working for the State of Ohio?
Check the appropriate area(s) of discrimination:




Check the appropriate area(s) of Discriminatory harassment:




Retaliation (based on involvement with a current or previous discrimination complaint):  
Race of the complainant: 
select
Sex of the complainant:
select
Employee Status:
select
Name of the agency you believe discriminated against you:  
select
*
Enter the Name(s) and title(s) of person(s) you believe discriminated against you:
Have you filed a complaint that involves similar issues with the federal Equal Employment Opportunity Commission (EEOC)? *
Have you filed a complaint that involves similar issues with the Ohio Civil Rights Commission (OCRC)? *
Have you filed a Union grievance regarding the incident(s)? *
Most recent date of alleged discrimination: *
State Agency where you were employed at the time of alleged discrimination: 
select
Your Job Classification at time of alleged discrimination: 
What term or conditions of employment discrimination do you feel occurred? 



* Explain when and how you believe you were discriminated against (treated differently from other employees or applicants) BECAUSE of your race, color, religion, sex, gender, national origin, ancestry, disability, age (40 years or more), sexual orientation, military status, veteran status or genetic information. Please provide additional sheets and attachments, if needed.
Complaint Submitted by:   *
You will have the opportunity to attach supporting documentation to this complaint after you select "Submit Discrimination Complaint".