EQUAL OPPORTUNITY OFFICE
CITY HALL 419 FULTON STREET RM 303 PEORIA, ILLINOIS 61602 TELEPHONE: 309-494-8842 (TTY: 309-494-8532) EMAIL: eoo@peoriagov.org
File a Discrimination Complaint
Please use this form to submit a discrimination complaint. * Please Note the City of Peoria does not have blanket jurisdiction over all complaints, in the event the city does not have jurisdiction over your complaint a referral will be made to the jurisdictional agency.
Please choose from the below options:
I am filing this complaint for myself
I am filing this complaint on behalf of a minor
I am an Equal Opportunities Commissioner making this complaint on behalf of the public
I am an attorney
Complainant
The person making the complaint of discrimination.
Name
*
First Name
Middle Name
Last Name
Additional Address Details
I don't have a permanent address
Care of
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Confirm Email
example@example.com
Preferred Communication
I prefer to receive written communication from the Equal Opportunity Office through:
Please indicate preference
*
Mail
Email
I have hired an attorney to assist with filing this complaint. (Note you do not need an attorney to file a complaint.)
Complainant's Contact Person
Name someone outside of your household who would know how to contact you. The Equal Opportunity Office will only contact this person if we are unable to reach you at the contact information you provided above.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Respondent
The employer, housing provider, business, or City of Peoria agency you believe discriminated against you. Note: If you wish to file a complaint against more than one Respondent, please submit an additional form. One respondent can only be investigated per complaint. If you have questions, please call us at (309)-494-8842.
Name of Employer, Housing Provider, Business, or City of Peoria Agency
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Back
Next
Complaint Information
This complaint is about
*
Employment
City Services
Housing (Housing complaints will be referred to the appropriate state or federal agency in accordance with City of Peoria IL Municipal Code: Chapter 17, Article III, Division 2, Section 17-75.)
Public Accomodation
When did the most recent incident of discrimination happen? (Approximate guess is OK.)
*
-
Month
-
Day
Year
Date Picker Icon
Where did the incident of discrimination occur? (City/State)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I believe I faced discrimination because I belong to the following protected class(es):
Although you may belong to many protected classes, only mark the box(es) of the protected class(es) that you feel you were discriminated against. Please note that not all classes are protected in every circumstance.
*
Age (40 & Older)
Arrest Record (not leading to conviction, juvenile records, or expunged/sealed/impounded records)
Building Code Complainant
Citizenship Status
Color
Conviction Record
Credit History
Disability
Domestic Partners
Familial Status
Gender Identity
Genetic Identity
Homelessness
Less than Honorable Discharge from Military
Marital Status
National Origin
Physical Appearance
Race/Ethnicity
Receipt of Rental Assistance
Religion/Non-Religion
Retaliation
Sex
Sexual Orientation
Social Security Number Disclosure
Source of Income
Student
Unemployment
Victim of Domestic Abuse, Sexual Assault, and/or Stalking
Reproductive Health Decisions
Ancestry
Military Status
Order of Protection Status
Work Authorization Status
Language
Immigration Status
What negative treatment or action did you experience?
*
Explain how you believe the negative treatment or action you received is related to each of the protected classes you selected?
*
What do you hope to get out of this process (only select the options that are most relevant to your complaint):
*
Apology
Attorney Fees
Difference in rent
Financial settlement
Job
Letter of reference
Lost Wages
Moving expenses
Out of pocket expenses
Reinstatement
Removal of personnel record
Training by appropriate agencies
Vacant unit
Other
If you selected Other, please provide additional details?
You will have the opportunity to submit electronic documentation of your complaint below.
*
I am 18 years of age or older.
By signing below, I hereby agree to comply with the Equal Opportunity Office Rules and to fully participate in the investigation of this complaint. I am aware that failure to do so may result in the dismissal of the case. Additionally, by signing below I hereby verify that facts and allegations are true to the best of my knowledge.
Date Signed
-
Month
-
Day
Year
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Please provide any supporting evidence (documents, photos, etc.)
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