TampaGov Discrimination/Employment

Use this service to determine if an employment concern is protected under the City of Tampa Human Rights Ordinance and/or other state and federal laws which protect persons from being discriminated against within the Tampa city limits because of their race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age, disability, familial status or marital status.

Please provide the name of an individual at a different address in your local area who would know how to reach you:

Name:
Relationship:
Phone:
Street Address:
City:
State:
Zip Code:

COMPLAINT INFORMATION:

* State briefly: What action was taken against you that you believe to be discriminatory? Indicate the harm, if any, caused to you or others in your work situation, as a result of such action.

*State briefly: Why do you believe this action was taken against you? It is a violation of the law to deny you your rights for any of the following bases: Race, Color, National Origin, Sex, Religion, Sexual Orientation, Gender Identity/Expression, Age, Disability, Marital Status, Familial Status (families with children under 18) or Retaliation (retaliation based on a protected activity).

Provide the name, address and telephone number of the employer, union (give local number), and / or employment agency that you believe discriminated against you.

* Name:
*Street Address:
*City:
* State:
*Zip Code:
Phone:

*What was the most recent date your alleged harm took place? (mm/dd/yyyy):

Normally, your identity as a Complainant will be disclosed to the organization which allegedly discriminated against you.

Consent Not Consent

Have you sought assistance about the action you think was discriminatory from any agency, an attorney, EEOC, the Florida Commission on Human Relations (FCHR) or from any other source?

Yes No

Name of Assistance Source:

Date:

Result if Any:

Have you filed, in the past, an employment discrimination complaint with the EEOC, FCHR, Tampa Office of Human Rights or or another local agency comparable to the Tampa Human Rights Office.?

Yes No

Complaint Filed With:

Name of Company Filed Against:

Complaint Number (if known):

Approximate Date Filed:

PRIVACY ACT STATEMENT: This form is covered by the Privacy Act of 1974; Public Law 93-579

Filling out and bring or sending us this questionnaire does not mean that you have filed a charge. Once you have submitted the completed form, you will be contacted by our office within 10 days. If you are not contacted in 10 days please call (813) 274-5835. Please be advised that there are time limits to file a charge, generally within 180 days or in some jurisdictions one (1) year of the alleged harm.

Office Mailing Address: 306 E. Jackson Street, 3N , Tampa, Florida, 33602

If you need an accommodation under the Americans with Disabilities Act to complete the questionnaire, please call (813) 274-5835

NOTE: You can upload attachments after submitting this form.

When you submit this form, you will receive a Tracking Number and Access Key allowing you to follow-up on this submittal.

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Discrimination/Employment

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