Eeo Complaint Form Page 2
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4Who do you believe committed an EEO violation against you? (Include names, titles and work locations of each
person)
________________________________________________________________________________________________
________________________________________________________________________________________________
Did the alleged EEO violation occur within the past 12 months?
Yes ___ No ____
When did the alleged EEO violation occur?
hours
Date/Time:
Where did it happen?
Location:
Describe what you believe are the discriminatory acts that have been committed against you that violated
the EEO Policy. Please use extra pages if necessary.
________________________________________________________________________________________
EEO -1 (08/08)
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