Technical Assistance Questionnaire for Employment
The primary purpose of this questionnaire is to solicit information about claims of employment discrimination, determine whether the Florida Commission on Human Relations (FCHR) has jurisdiction over those claims and educate complainants on the investigative process, as appropriate.
Providing this information is voluntary, but the failure to do so may impede the Commission’s investigation of a charge.
The FCHR may disclose the information included on this form to other state, local and federal agencies, as appropriate or necessary to carry out the Commission’s functions, or if the FCHR becomes aware of a civil or criminal law violation.
Please Note: If you have filed a Federal EEOC Claim, do not proceed with this form
Your answers to this questionnaire are confidential pursuant to Florida Statute 760.11(12).
This form is solely an information-gathering tool which will allow us to draft an official charge form. The official complaint form must be signed, dated, verified, and returned to the Florida Commission on Human Relations office. Failure to return a signed complaint form will close your complaint.
Please complete this entire form and submit it to the Commission at the end of this form. Answer all questions completely. Fax or mail any additional pages if needed to complete your responses.
If you do not know the answer to a question, answer by stating “not known.” If a question is not applicable, type “N/A.” Failure to complete this questionnaire in its entirety may delay processing.
REMEMBER, a complaint of employment discrimination must be filed within 365 days of the alleged act of discrimination. This questionnaire is not a complaint form.