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Get FL Charge of Discrimination

Ate Mr., Ms., or Mrs.) Home Telephone ( Street Address City, State and Zip Code ) County NAMED IS THE EMPLOYER, LABOR ORGANIZATION, EMPLOYMENT AGENCY, APPRENTICESHIP COMMITTEE, STATE OR LOCAL GOVERNMENT AGENCY WHO DISCRIMINATED AGAINST ME (If more than one list below) Name No. of Employees/Members Street Address City, State and Zip Code Telephone ( CAUSE OF DISCRIMINATION BASED ON (Check appropriate box(es)) G RACE GAGE G COLOR G SEX G RETALIATION G RELIGION G NATIONAL ORIGIN GOTH.

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