Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 11Checkboxes *I am being harassedI am being discriminated againstI am working in an unsafe environmentI was injured at workI was retaliated againstI am owed wagesI was wrongfully terminatedOtherNextHarassment *Sexual HarassmentPhysical Harassment (Unwanted Non-Sexual Contact)Verbal HarassmentPreviousNextDiscrimination *RacePregnancyReligionGenderDisabilityAgeMilitary or Veteran StatusMarital StatusPreviousNextUnsafe Work Enviroment *Dangerous Work SiteOffice in Need of RepairHostile Work EnvironmentPreviousNextInjured at Work *Filed a Workers Compensation ClaimDid Not File a Workers Compensation ClaimPreviousNextRetaliation *DemotedExcludedReassignedHours CutPreviousNextOwed Wages *Unpaid OvertimeUnpaid Paid Time Off (PTO)Unpaid BenefitsPreviousNextHave you filed a complaint with the California Civil Rights Department (CRD) or Equal Employment Opportunity Commission (EEOC)?YesNoPreviousNextAre You Still Emloyed? *YesNoPreviousNextPlease Describe What Happened *PreviousNextName *FirstLastEmail *Phone *PreviousSubmit