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Web Form - Employ SeBC revisions - 20160701forweb

Web Form - Employ SeBC revisions - 20160701forweb 2026

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The document is a confidential employment intake questionnaire from the New Hampshire Commission for Human Rights, designed to collect information regarding potential discrimination cases. It clarifies that submitting the questionnaire does not constitute filing a charge of discrimination. The form requests personal details, reasons for perceived discrimination, and specifics about the employer involved. It also outlines the process for further investigation and emphasizes the importance of timely submission within 180 days of the last discriminatory act.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name and today's date in the designated fields at the top of the form.
Fill out your address, city, state, zip code, and telephone numbers. Ensure all contact information is accurate for follow-up.
Indicate whether you have previously filed a charge of discrimination with the EEOC by selecting 'YES' or 'NO'.
Provide optional demographic information such as race and national origin if comfortable.
Select the reasons for discrimination from the provided options, ensuring to check all that apply.
Document the first and last dates of discrimination, paying attention to the 180-day filing limit.
Detail any specific incidents where you believe discrimination occurred in the relevant section.
Complete employer information including name, address, and contact details before submitting your form.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (122 Votes)

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