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Please fill this form then send it to us and we will return to you as soon as possible.
Name of Company or Organization with which you have a dispute.
About how many employees work for this company?
Approximate date when you started working for this company (mm/dd/yy)
Your Job Title
If you have been terminated or any other adverse decision, when did you learn this would happen to you?
Briefly describe your problem or situation.
Have you filed a charge of discrimination with the EEOC (or a state agency)?
If so, when?
Have you received a "right to sue" letter from the EEOC (or a state agency)?