New jersey discrimination 2026

1. Click ‘Get Form’ to open the New Jersey Discrimination form in the editor.
2. Begin by entering your personal information in Section 01 through 04, including your name, Social Security Number, complete home address, and telephone numbers.
3. In Section 06, select the nature of your complaint by checking the appropriate box that reflects whether you were discriminated against for filing a workers' compensation claim or for testifying.
4. Provide details about your employer in Sections 07 through 10, including their name, identification number (if known), and contact information.
5. If you checked box 'a' in Section 06, complete items 12 through 20 regarding your workers' compensation insurance carrier and details about your accident or illness.
6. If you checked box 'b', fill out items 21 through 26 related to testimony in a workers' compensation case.
7. Finally, review all entries for accuracy before signing at the end of the form to affirm that the information provided is true.

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