EEO Complaint Form

INSTRUCTIONS

This form is for Equal Employment Opportunity (EEO) complaints only. Please click here for the County's EEO Policy for more information.

Complete Sections A-D and provide as much detail as possible.

If you have any questions related to this form, contact EEO.Support@ocgov.com or call 714-834-7511.

Anonymous EEO Complaints: If you would like to file your complaint anonymously, call the EEO Compliance line at 855-387-4432. The Compliance Line is a third-party hotline with live operators available to answer your call 24 hours a day, 7 days a week.

Abusive Conduct or Bullying Complaints: If you have an abusive conduct or bullying complaint that does not include a protected category, do not use this form. Contact your department's HRS Manager or HRS@ocgov.com. Please click here (P8-P10) for the County's Abusive Conduct Prevention Policy for more information.

Recruitment Complaints: If you have a recruitment complaint that does not include a protected category, do not use this form. You can find the Recruitment Complaint form here.

SECTION A - COMPLAINANT

First Name:

Middle Name:

Last Name:

Work Location Street:

Work Location City:

Work Location Zip:

Work Phone #:

Mobile Phone #:

Email:

I prefer to be contacted by:

Mobile Phone Email

I am a current County of Orange Employee:

Yes No

Class Title:

Department:

I am filing this complaint related to the conduct of the following individual(s):

Full Name	Class Title	Agency/Department

SECTION C - FOR COUNTY EMPLOYEES ONLY

9) If County employee, have you filed a grievance regarding this matter?

Yes No

Date grievance was filed:

10) Are you being represented by a labor organization?

Yes No

Full Name:

Union:

Phone #:

Email:

11) Do you have an attorney?

Yes No

SECTION D - ACKNOWLEDGEMENT

Read Before Signing:

The County strongly encourages anyone who in good faith believes they may be the victim of discrimination, harassment, or retaliation to report such conduct. However, the filing of a knowingly and intentionally false claim violates County policy and may result in discipline up to and including discharge.

I acknowledge that I have read the paragraph above

By submitting this form, I confirm that to the best of my knowledge, all the information contained herein is accurate. I understand that the Equal Employment Opportunity Access Office and/or other authorized County personnel will investigate my complaint, and, if necessary, share information with other parties to fulfill its obligations under County policy and any applicable law or order.

Enter your name (in lieu of your signature):

Date:

11/21/2024

ID	Full Name	Job Title	Phone Number