Durham County Non-Discrimination Ordinance Complaint Process

Durham County Non-Discrimination Ordinance Complaint Process
Your Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Name of the person, business, agency, or institution you are charging with discrimination:
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Address Where the Alleged Discrimination Occurred: *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this address inside the Durham County limits?*

YesNo
Is this address inside a municipal limit?*

YesNo
This alleged discrimination occurred in:*

EmploymentPublic Accommodations
Date the alleged discrimination occurred:*

MonthDayYear
Date
The alleged discrimination was because of (Check one):*

Race (including natural hair or hairstyles)EthnicityCreedColorSexPregnancyMarital or Familial StatusSexual OrientationGender Identity or ExpressionNational Origin or Ancestry (including natural hair or hairstyles)Military StatusReligious Belief or Non-beliefAgeDisability
Have you filed a complaint with any other business, organization, court, or governmental organization?*

YesNo
If yes, please complete the following:
Name of Organization or Agency
Date of Filing

MonthDayYear
Date
Status of Complaint
DISCLAIMER & ACKNOWLEDGMENT:

Complainant acknowledges that:

- Submission of this form does not constitute legal representation by the County or the County’s third-party conciliation facilitator.

- Complainant may independently pursue separate claims under state or federal law and further acknowledges that it is their duty to seek independent advice from their own legal counsel as to any remedies, deadlines or statute of limitations that exist under law.

- The County’s acceptance of a complaint against employers that are exempt from the EEO laws does not create a basis for filing a claim against them with the EEOC.

- Submission of a complaint to the County does not bind the County to seek a remedy on behalf of the Complainant and a conciliation referral by the County does not guarantee participation of the Respondent or resolution of the dispute.

- Information submitted to the County may be subject to disclosure under the N.C. Public Records Act.
I affirm that this complaint is true to the best of my knowledge and information*

Clear
Date*

MonthDayYear
Date
Please explain your reasons for filing your complaint. Explain why you believe you were discriminated against. Be specific and use as many characters as necessary:*
Please verify that you are human*
Should be Empty: