COMPLAINT OF DISCRIMINATION NEW JERSEY LAW AGAINST DISCRIMINATION Completion of this form does not constitute filing of an official complaint with the legal authority. At this time, the NAACP is only seeking information to assist you concerning this complaint. Your Name Address Street Address Street Address Line 2 City, State, Zip Code Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming State Zip Code PHONE HOME PHONE WORK PHONE OTHER Do you believe that the discrimination was because of? Race or ColorReligionNational OriginSex AgeHandicap StatusSexual OrientationA Typical Cellular Disorder Who discriminated against you? Give the name, address, employer, labor organization, employment agency, apprenticeship committee, licensing agency, etc. Name Address Street Address Street Address Line 2 City, State, Zip Code Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Have you filed a complaint with any governmental agency (ies)? YesNo If YES, please give details Have you filed a grievance with the Union? Name of Local Representative? Have you retained an attorney regarding this complaint/case? YesNo Name of Attorney? Address Address Street Address Line 2 City, State, Zip Please Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming State Zip Code The actual date or most recent date on which this discrimination occurred: Time of Day Hour Minutes AM PM AM/PM Option Month, Day, Year -Month -DayYearDate Please explain what was done or said to you that you believe constitutes unlawful discrimination I, affirm that I have read the above charge and that it is true to the best of my knowledge, information and belief. Signature of Complainant Clear Date /Month /DayYearDate Name of NAACP Official handling the complaint Date /Month /DayYearDate Submit Should be Empty: Now create your own Jotform - It's free!Create your own Jotform Previous Post 2023 NAACP Newark Teacher Honor Roll Rafeeza Shahabudeen Next Post NEWARK WOMEN PRESIDENTS TRIBUTE
