North Carolina Department of Correction
Equal Employment Opportunity Office
EEO Complaint Form

Name:

Home phone with area code:

 Cell Phone:

Mailing Address: 

Work location: Work Telephone:
   Division: Position Title:
   Facility: Work hours:
   Work Location: Immediate Supervisor:
Type of Complaint:
Basis of Charge:
Race National Origin
Sex Age
Creed Disability
Religion Color
Genetic Information Political Affiliation
Sexual Orientation
Discrimination
Workplace Harrassment
Retaliation
Other (please specify)
Most Recent Dates discrimination took place:
Continuing? Yes   No
Description of charges - Must provide a narrative description of the complaint including what happened, dates(s) of alleged incidents(s), the harrasser(s) or respondents(s) and witnesses, including their full names, position titles, and work locations, if known.
Supporting documentation may be faxed to (919) 716-3958. Please include your full name, work location, and contact number.


Please click submit only once and wait for confirmation that your submission was received.