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CITY OF ROCK ISLAND HUMAN RIGHTS COMMISSION DISCRIMINATION COMPLAINT
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CITY OF ROCK ISLAND HUMAN RIGHTS COMMISSION
DISCRIMINATION COMPLAINT FORM
COMPLAINANT INFORMATION (The complainant or the accused must reside or be located in Rock Island, IL)
I believe that I have been discriminated against on the basis of:
Explain selection of other:
Name the party you believe discriminated against you (Person/Organization/Business)?
City (The complainant or the accused must reside or be located in Rock Island, IL)
Describe how and why you believe you were discriminated against? Please be as specific as possible
List the date(s) you believe the discrimination took place?
What resolution or solution are you seeking? Once a completed complaint is received, the Commission can work with the parties involved to mediate the dispute and work toward a resolution. In some cases a complaint may be referred to the Illinois Department of Human Rights or another agency for resolution.
Has a complaint been filed with any Federal, State of local investigative agency?
If “Yes” then complete the following:
Name of Agency
Name of Contact:
I hereby affirm that the above information is true to the best of my knowledge:
Signature (Enter Name)
Questions call: 309.732.2999
Filing a complaint with the Rock Island Human Rights Commission should not take the place of filing a complaint with the US Equal Employment Opportunity Commission, the Illinois Department of Human Rights or any other federal or state agency which may address issues of discrimination. The function of the Rock Island Human Rights Commission is to provide mediation. In order to preserve your legal rights and potential remedies under various federal and state statutes, the appropriate agency or private legal counsel should be contacted particularly regarding the timing of filing a complaint.
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