Equal Employment Opportunity (EEO) Complaint Form

County of Sonoma - Equal Employement Opportunity Unit

575 Administration Drive #116B, Santa Rosa, CA 95403

(707)565-8059

A PDF version of the Form Available to download and complete here in place of this e-form. More information about Equal Employment Opportunity (EEO) / Americans with Disabilities Act (ADA) Public Access Division can be found on our website here.

DISCLOSURE: The County of Sonoma takes all allegations seriously and has a compelling interest in protecting the integrity of its investigations. As such, any information stated in this form could be disclosed to those who have a legitimate need to know, and in compliance with applicable federal, state, and local laws.

Complainant's Information

Complainant's Full Name

Employee ID Number

Department

Job Title

Mailing Address (Address, City, State, Zip)

Physical Work Location Address (Address, City, State, Zip)

Home/Cell Number

Work Phone Number

Email Address

User Email

NULL Email

Preferred Contact Method

Home/Cell Number

Work Number

Teams

Complainant's Signature

Signature Date

Please list any witnesses whom you feel may have information regarding this complaint

You may include up to 4 witnesses information

Witness 1 Full Name and Contact Information

Job Title

Department

Relevant Information Your Witness Could Have

Add a 2nd witness

Witness 2 Full Name and Contact Information

Job Title 2

Department 2

Relevant Information Your Witness Could Have 2

Add a 3rd witness

Witness 3 Full Name and Contact Information

Job Title 3

Department 3

Relevant Information Your Witness Could Have 3

Add a 4th witness

Witness 4 Full Name and Contact Information

Job Title 4

Department 4

Relevant Information Your Witness Could Have 4

Remedy/Resolution

What remedy is sought?

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EEO Complaint Form

Complainant's Information

Individual(s) responsible for alleged harassment / discriminatory /retaliatory actions

Allegation Details

Please list any witnesses whom you feel may have information regarding this complaint

Remedy/Resolution