Right To Privacy In The Workplace Complaint Form

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File Number

Complainant follow-up since submitting complaint?

Yes

Status

Complainant Name

Complainant Address

Complainant City

Complainant State

Complainant ZIP

Complainant Email

Complainant Phone

Date Hired

Last Day Worked

Job Title

Employer Name of Business

Employer Address

Employer City

Employer State

Employer ZIP

Supervisor's Name

Supervisor's Phone

Industry

Are you alleging discrimination for use of lawful products?

Employment-related action your employer or prospective employer has taken against you for the use of any lawful product outside the workplace during non-working hours.

Are you alleging E-Verify Non-Compliance?

Failure of employer who is using the Employment Eligibility Verification System (E-Verify) to post required Department of Homeland Security and Office of Special Counsel notices in a prominent place clearly visible to prospective employees.

Are you alleging Computer Based Tutorial Non-Compliance?

Failure of employer representatives who are performing employment verification queries to complete the Computer Based Tutorial.

Are you alleging E-Verify Privacy Non-Compliance?

Failure of employer to maintain privacy of employee information contained in E-Verify or to secure access to that System.

Are you alleging unlawful Social Media Inquiry?

Employment related issue relating to employer or prospective employer requiring me to provide my password and/or account information in order for the employer or prospective employer to gain access to my account or profile on a social networking website.

Describe The Complaint

Please attach additional documents if necessary.

Accept and Submit

BY ACCEPTING AND SUBMITTING THIS FORM, THE COMPLAINANT AFFIRMS AND CERTIFIES THAT ALL INFORMATION PROVIDED AND THE STATEMENTS MADE HEREIN ARE TRUE, CORRECT, AND COMPLETE.

Attachments

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Right To Privacy In The Workplace Complaint Form

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Right To Privacy In The Workplace Complaint Form

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