Right To Privacy In The Workplace Complaint Form

File Number

Complainant follow-up since submitting complaint?

Yes

Status

Active Closed Hearing Second Letter Sent

Complainant Name

Please fill out this field.

Complainant Address

Please fill out this field.

Complainant City

Please fill out this field.

Complainant State

AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Please fill out this field.

Complainant ZIP

Please fill out this field.

Complainant Email

Complainant Phone

Date Hired

Last Day Worked

Job Title

Employer Name of Business

Please fill out this field.

Employer Address

Please fill out this field.

Employer City

Please fill out this field.

Employer State

AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Please fill out this field.

Employer ZIP

Please fill out this field.

Supervisor's Name

Supervisor's Phone

Industry

Accounting Advertising Aerospace Agriculture Aircraft Airline Apparel & Accessories Automotive Banking Biotechnology Broadcasting Brokerage Call Centers Car Wash Cargo Handling Chemical Cleaning Services - Home & Office Computer Construction/Landscaping Consulting Consumer Products Cosmetics Day and Temporary Labor/Staffing Defense Department Stores Education Electronics Energy Entertainment & Leisure Executive Search Fast Food Financial Services Food, Beverage & Tobacco Government Grocery Health Care Insurance Internet Publishing Investment Banking Laundry Services Legal Lodging/Hospitality Manufacturing Motion Picture & Video Music Newspaper Publishers Non-Profit Online Auctions Pension Funds Pharmaceuticals Private Equity Publishing Real Estate Restaurant Retail & Wholesale Securities & Commodity Exchanges Security Company Service Soap & Detergent Software Sports Technology Telecommunications Television Transportation Venture Capital

Please fill out this field.

Are you alleging discrimination for use of lawful products?

Employment-related action your employer or prospective employer has taken against you for the use of any lawful product outside the workplace during non-working hours.

Are you alleging E-Verify Non-Compliance?

Failure of employer who is using the Employment Eligibility Verification System (E-Verify) to post required Department of Homeland Security and Office of Special Counsel notices in a prominent place clearly visible to prospective employees.

Are you alleging Computer Based Tutorial Non-Compliance?

Failure of employer representatives who are performing employment verification queries to complete the Computer Based Tutorial.

Are you alleging E-Verify Privacy Non-Compliance?

Failure of employer to maintain privacy of employee information contained in E-Verify or to secure access to that System.

Are you alleging unlawful Social Media Inquiry?

Employment related issue relating to employer or prospective employer requiring me to provide my password and/or account information in order for the employer or prospective employer to gain access to my account or profile on a social networking website.

Describe The Complaint

Please attach additional documents if necessary.

Accept and Submit

Yes

BY ACCEPTING AND SUBMITTING THIS FORM, THE COMPLAINANT AFFIRMS AND CERTIFIES THAT ALL INFORMATION PROVIDED AND THE STATEMENTS MADE HEREIN ARE TRUE, CORRECT, AND COMPLETE.

Attachments

Choose Files

Multiple files can be uploaded by holding down Shift or Ctrl while selecting.

Submit

Reset