Get Retaliation Complaint Elder Abuse Form

This guide aims to assist users in completing the Retaliation Complaint Elder Abuse Form online. By following the instructions provided, you will ensure that your complaint is filled out accurately and submitted correctly.

Follow the steps to complete your retaliation complaint form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the complainant information section. Include your first name, last name, and middle name. Then provide your street address, city, state, and zip code. Add your home and work telephone numbers, and specify if it is okay for the Equal Rights Division to contact you at work.
3. Next, provide detailed information about the respondent. Include the name of the organization or company that you believe retaliated against you, along with their street address, city, state, and zip code. Also include their telephone number and the type of business they operate.
4. Describe the protected action you took, such as filing a complaint or reporting misconduct. Be sure to include the date of each action in the specified format (month/day/year). If you have not taken any action, skip to question 5.
5. If applicable, detail whether you communicated with someone regarding your protected action. Specify the name, title, and contact information of the person you talked to, along with what you said and when.
6. If you did not answer question 3 or answered 'No' to question 4, describe what action you believe your employer thought you would take, including any relevant dates and the name and title of the individual who held that belief.
7. In the following section, list any employment actions your employer took in response to your action or suspected action. Include the type of action (e.g., termination, demotion) and the date it occurred. If there are more than four actions, provide the information on a separate sheet.
8. Finally, you must certify the accuracy of your complaint by signing and dating the signature section. Remember that your signature is essential for the processing of your complaint.
9. Mail your completed and signed complaint to the appropriate Equal Rights Division office, ensuring you have all required documents, including the Process Information Sheet.

Take action today by completing and submitting your Retaliation Complaint Elder Abuse Form online.