File Discrimination Complaint

This form is to be used for complaints against the Missouri Department of Labor and Industrial Relations (DOLIR) or its employees in the provision of services to the public. This form is not to be used for filing complaints with the Missouri Commission on Human Rights (MCHR) under the Missouri Human Rights Act (MHRA). For information regarding MCHR and MHRA, visit labor.mo.gov/discrimination.

Fill out below or print, complete this equal opportunity complaint form and mail to:
Equal Opportunity Officer
Missouri Department of Labor
P.O. Box 59
Jefferson City, MO 65104-0059
Phone: 573-751-1339 Fax: 573-751-4945
E-mail: EO@labor.mo.gov

Discrimination Complaint Information

To the best of your recollection on what date(s) did the discrimination take place?

Basis of Complaint: Which of the following best describes why you believe you were discriminated against. (Check ALL that apply.)
Unlimited number of files can be uploaded to this field.
25 MB limit.
Allowed types: jpg, png, odf, pdf, doc, docx, ppt, pptx, xls, xlsx.

Please list below any persons (witnesses, fellow employees, supervisors, or others) that we may contact for additional information to support or clarify your complaint - if more than one, please upload file with their information below:

Unlimited number of files can be uploaded to this field.
256 MB limit.
Allowed types: jpg, png, odf, pdf, doc, docx, ppt, pptx, xls, xlsx.
Do you have an attorney?
Have you filed a case or complaint with any of the following?

For each item checked above, please provide the following information (other information can be uploaded below):

One file only.
256 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
Have you received a final decision regarding your complaint from the Federal or State agency(ies) you have filed it with?

(Complaint NOT valid unless signed):

Please Note: If you elect to file your complaint with the Missouri Department of Labor & Industrial Relations (DOLIR), you must wait until the DOLIR issues a decision or until 90 days have passed, whichever is sooner, before filing with the U.S. Department of Labor, Civil Rights Center (CRC), 200 Constitution Avenue, NW, Room N 4123, Washington DC 20210. If the DOLIR has not provided you with the written decision within 90 days of the filing of the complaint, you need not wait for a decision to be issued, but may file a complaint with the CRC within 30 days of the expiration of the 90-day period. If you are dissatisfied with the resolution of your complaint, you may file a complaint with the CRC. Such complaints must be filed within 30 days of the date you received notice of the resolution.

Sign above

The Missouri Department of Labor & Industrial Relations is an equal opportunity employer and complies with all state and federal nondiscrimination laws in the administration of its programs.