Discrimination Alert Form


Enter Your Discrimination Event Info:


Name of Witensses:

Full Address Include State:

Type of Violation Race Religion Age etc.:

Date of the Violation:

Discrimination is not acceptable at any work location and against federal law, thank you for submiting your violation report we will respond if you have reqeusted a response in your report statement.





Discrimination Policy: Discrimination of any kind is not acceptaple and needs to be reported immediatley. Our report violation page is an annonymous page that any employee can use to notify Human Resources of a violoation they have either witnessed or been a vicitim of discrimination or harrassement. Our discrimination policy is also posted, according to federal law, at all of our locations and within the website through the HR Forms Link. The Federal government’s Civil Rights Center. If you would like to file your complaint with the Civil Rights Center, please send it to this address: U.S. Department of Labor Civil Rights Center 200 Constitution Ave. NW Room N4123 Washington, DC 20210 If you have any questions, you may contact CRC by phone or e-mail: Phone: (202) 693-6500 TTY/TDD: (202) 693-6516 Email: CivilRightsCenter@dol.gov Or check CRC’s website:

CRC’s business hours are 9 am to 5 pm, Eastern Time.

Digital Signature Accordance

State of Florida Digital Signature Legal Disclaimer: The appropriate format, which must be retrievable or reproducible in typewritten or printed form and must be legible. In accordance with Florida's digital form capture statute future market growth expected in all states.

s.15.16 F.S Reproduction of records; admissibility in evidence; electronic receipt and transmission of records; certification; acknowledgment. (b) The manner of execution, which may include any symbol, manual, facsimile, conformed, or electronic signature adopted by a person with the present intent to authenticate a document. In accordance with the state of Florida and the Uniform Electronic Transaction Act digital form capture statute future market growth expected in all states.





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