[City of Sacramento] Charge of Discrimination Form

City of Sacramento Equal Employment Office

Discrimination Complaint Form

To protect the confidentiality of your complaint, please be advised that your complaint is submitted directly to the City of Sacramento’s Equal Employment Opportunity Office. Upon receipt, the EEO Office will keep the complaint confidential to the extent possible for a thorough investigation. If you have any questions, EEO Staff can be reached at (916) 808-5825 or EEO@cityofsacramento.org.

Phone Number

Relationship to the City

Current/Former Employee Job Title

Indicate the person or persons who discriminated against you.

Name

Work Phone Number

Job Title

Add another person who discriminated against you.

Yes

Name

Work Phone Number

Job Title

Date of most recent act of discrimination

Indicate the remedy you seek.

Give a concise statement on how you have been discriminated against.

Sign Here (Please note that failure to complete and submit a Charge of Discrimination Form shall not preclude an inquiry/investigation).

First Name

Last Name

Choose how to sign

Draw Type

I declare that the above charge is true to the best of my knowledge, information and belief.