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<!DOCTYPE html>
<html lang="ht">
<head>
<title>OFCCP Complaint Form Creole</title>
<!------------------------------------
META
------------------------------------->
<meta http-equiv="Content-type" content="text/html;charset=UTF-8">
<meta http-equiv="Content-Style-Type" content="text/css">
<meta name="generator" content="">
<meta name="viewport" content="width=device-width, initial-scale=1.0"/>
<!------------------------------------
LINK
------------------------------------->
<link rel="stylesheet" type="text/css" media="screen" href="dol_screen_creole.css">
<link rel="stylesheet" type="text/css" media="screen and (max-width: 778px)" href="ipad_creole.css">
<link rel="stylesheet" type="text/css" media="screen and (max-width: 635px)" href="iphone_creole.css">
<script src="dol_style_creole.js"></script>
<!-------------------------------------------------------
STYLE GUIDE
-------------------------------------------------------->
<script>
function instructions() {
document.myform2.submit();
}
</script>
<!-------------------------------------------------------
STYLE GUIDE
-------------------------------------------------------->
<script>
function clear_form() {
document.myform.reset();
return false;
}
</script>
</head>
<!------------------------------------
COMPLAINT FORM
------------------------------------->
<body OnKeyPress="return disableKeyPress(event)" onload="check_date_required('Print_Signature_Date')">
<div class="scrn-rdr">
<a href="#maincontent">Sote pou al nan Seksyon Prensipal la</a>
</div>
<div class="form_center">
<!------------------------------------
TOP
------------------------------------->
<div class="top-1-left">
<a style="float: left;" href="https://www.dol.gov">
<img src="https://raw.githubusercontent.com/GSA/logo/master/labor.png" align="top" width="45" border="0" alt="United States Department of Labor" title="United States Department of Labor">
</a>
<a style="float: left;" href="https://www.dol.gov/ofccp/aboutof.html">
<img src="https://www.dol.gov/sites/default/files/slide47.jpg" align="top" width="155" border="0" alt="Office of Federal Contract Compliance Programs" title="Office of Federal Contract Compliance Programs">
</a>
</div>
<div class="top-1-right">
<h1 class="title_top" >Plent ki Konsène Pratik Diskriminasyon yon Kontraktè oswa Sou-Kontraktè Gouvènman Federal nan Travay</h1>
</div>
<div class="top-link">
<form name="myform2" action="http://www.conceptlabs.com/viateq/demo/complaint_submission.asp" method="POST">
<input type="hidden" name="Form_Language" id="Form_Language" value="Creole">
<input type="hidden" name="Instructions" id="Instructions" value="Show">
<div class="read_instructions" id="read_instructions">
<a href="javascript:instructions();">Tanpri li enstriksyon yo epi ranpli fòm sa a.</a>
</div>
</form>
</div>
<div class="Form_Main">
<form name="myform" id="myform" action="http://www.conceptlabs.com/viateq/demo/complaint_submission.asp" method="POST" onsubmit="return validateForm();">
<input type="hidden" name="Instructions" id="Instructions" value="NoShow">
<input type="hidden" name="Form_Language" id="Form_Language" value="Creole">
<div class="top-2-left" >
<p>OMB: 1250-0002</p>
<p>Ekspire: 5/31/2020</p>
</div>
<div class="top-2-right" >
<input class="button_exec" id="button_exec" type="button" onclick="return clear_form()" value="Re-Inisyalize">
<input class="button_exec" id="button_exec" type="button" onclick="return print_form()" value="Enprime">
<input class="button_exec" id="button_exec" type="button" onclick="return validateForm()" value="Soumèt">
</div>
<!------------------------------------
SECTION 1
------------------------------------->
<div class="column-left-1">
<h2 id="maincontent" tabindex="-1">Kijan nou kapab kontakte ou?</h2>
</div>
<div class="column-right-1">
<div class='stack'>
<label for="Fullname1">Nonn (Prenon, Dezyèm Prenon, Non Fanmi):</label>
<input size="35" type="text" name="Fullname1" id="Fullname1" onchange="return check_name_required('Fullname1')" maxlength=50>
</div>
<div class='stack'>
<label for="Address1">Nimewo Kay: </label>
<input size= "50" type="text" name="Address1" id="Address1" onchange="return check_address_required('Address1')" maxlength=50>
</div>
<div class='stack4'>
<label for="City1">Vil:</label>
<input size= "50" type="text" name="City1" id="City1" onchange="return check_city_name_required('City1')" maxlength=50>
</div>
<div class='sameline'>
<label for="state1">Eta:</label>
<select style="width: 125px;" name="state1" id="state1" size="1" onchange="return check_state_required('state1')">
<option value="">Chwazi yon eta..</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District Of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="GU">Guam</option>
<option value="PR">Puerto Rico</option>
<option value="VI">Virgin Islands</option>
</select>
</div>
<div class='sameline_zipcode'>
<label for="Zipcode1">Kòd Postal:</label>
<input size= "10" type="text" name="Zipcode1" id="Zipcode1" onchange="return check_zipcode('Zipcode1')" maxlength=10>
</div>
<div class='stack24'>
<label for="Telephone1">Nimewo Telefòn:</label>
<input size= "15" type="text" name="Telephone1" id="Telephone1" onchange="return check_telephone_not_required2('Telephone1')" maxlength=15>
</div>
<div class='sameline'>
<input value="1" id="Home1" name="Telephone_type1" type="checkbox" onkeypress="return button_on_or_off2(event,'Home1')" >
<label for="Home1">Lakay</label>
<input value="2" id="Work1" name="Telephone_type1" type="checkbox" onkeypress="return button_on_or_off2(event,'Work1')" >
<label for="Work1">Travay</label>
<input value="3" id="Cell1" name="Telephone_type1" type="checkbox" onkeypress="return button_on_or_off2(event,'Cell1')" >
<label for="Cell1">Selilè</label>
</div>
<div class='stack'>
<label for="Email1">Adrès Imèl: </label>
<input type="text" size=60 onchange="return check_email('Email1')" name="Email1" id="Email1" maxlength=60>
</div>
<div class='stack2'>
<p class="spcdwnup">Èske ou te depoze akizasyon pou diskriminasyon nan travay ba yon lòt ajans federal oswa lokal?</p>
</div>
<div class='stack'>
<input value="1" id="Allegations_Yes" name="Allegations1" type="checkbox" onkeypress="return button_on_or_off(event,'Allegations_Yes','Allegations_No')" onclick="return mouse_on_or_off('Allegations_Yes','Allegations_No')">
<label for="Allegations_Yes">Wi</label>
<input value="2" id="Allegations_No" name="Allegations1" type="checkbox" onkeypress="return button_on_or_off(event,'Allegations_No','Allegations_Yes')" onclick="return mouse_on_or_off('Allegations_No','Allegations_Yes')">
<label for="Allegations_No">Non</label>
</div>
<div class='stack24'>
<label for="Agency_Name1">Si ou reponn wi, ki ajans:</label>
<input size= "40" type="text" name="Agency_Name1" id="Agency_Name1" onchange="return check_agency_name('Agency_Name1')" maxlength=50>
</div>
<div class='sameline'>
<label for="Agency_POC1">Non pou kontakte:</label>
<input size="20" type="text" name="Agency_POC1" id="Agency_POC1" onchange="return check_allegations_contact_name('Agency_POC1')" maxlength=30>
</div>
<div class='sameline'>
<label for="Agency_Telephone1">Nimewo Telefòn:</label>
<input size="15" type="text" name="Agency_Telephone1" id="Agency_Telephone1" onchange="return check_agency_telephone('Agency_Telephone1')" maxlength=15>
</div>
</div>
<!------------------------------------
SECTION 2
------------------------------------->
<div class="column-left-2" >
<h2>Kimoun nou kapab kontakte si nou pa kapab jwenn ou?</h2>
</div>
<div class="column-right-2" >
<div class='stack'>
<label for="Fullname2">Nonn (Prenon, Dezyèm Prenon, Non Fanmi):</label>
<input size= "35" type="text" name="Fullname2" id="Fullname2" onchange="return check_contact_name('Fullname2')" maxlength=50>
</div>
<div class='stack'>
<label for="Address2">Nimewo Kay: </label>
<input size= "50" type="text" name="Address2" id="Address2" onchange="return check_contact_address('Address2')" maxlength=50>
</div>
<div class='stack4'>
<label for="City2">Vil:</label>
<input bgcolor="#3CBC8D" size= "50" type="text" name="City2" id="City2" onchange="return check_contact_city_name('City2')" maxlength=50>
</div>
<div class='sameline'>
<label for="state2">Eta:</label>
<select style="width: 125px;" name="state2" id="state2" size="1" >
<option value="">Chwazi yon eta..</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District Of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="GU">Guam</option>
<option value="PR">Puerto Rico</option>
<option value="VI">Virgin Islands</option>
</select>
</div>
<div class='sameline_zipcode'>
<label for="Zipcode2">Kòd Postal:</label>
<input size= "10" type="text" name="Zipcode2" id="Zipcode2" onchange="return check_contact_zipcode('Zipcode2')" maxlength=10>
</div>
<div class='stack24'>
<label for="Telephone2">Nimewo Telefòn:</label>
<input size= "12" type="text" name="Telephone2" id="Telephone2" onchange="check_contact_telephone('Telephone2')" maxlength=15>
</div>
<div class='sameline'>
<input value="1" id="Home2" name="Telephone_type2" type="checkbox" onkeypress="return button_on_or_off2(event,'Home2')" >
<label for="Home2">Lakay</label>
<input value="2" id="Work2" name="Telephone_type2" type="checkbox" onkeypress="return button_on_or_off2(event,'Work2')" >
<label for="Work2">Travay</label>
<input value="3" id="Cell2" name="Telephone_type2" type="checkbox" onkeypress="return button_on_or_off2(event,'Cell2')" >
<label for="Cell2">Selilè</label>
</div>
<div class='stack'>
<label for="Email2">Adrès Imèl: </label>
<input type="text" id="Email2" name="Email2" size=60 onchange="return check_contact_email('Email2')" maxlength=60>
</div>
</div>
<!------------------------------------
SECTION 3
------------------------------------->
<div class="column-left-3">
<h2>Ki non patwon ou kwè ki te fè diskriminasyon oswa vanjans kont ou?</h2>
</div>
<div class="column-right-3">
<div class='stack'>
<label for="Fullname3">Konpayi Non:</label>
<input size= "50" type="text" name="Fullname3" id="Fullname3" onchange="return check_company_name_required('Fullname3')" maxlength=50>
</div>
<div class='stack'>
<label for="Address3">Nimewo Kay: </label>
<input size= "50" type="text" name="Address3" id="Address3" onchange="return check_company_address_required('Address3')" maxlength=50>
</div>
<div class='stack4'>
<label for="City3">Vil:</label>
<input size= "50" type="text" name="City3" id="City3" onchange="return check_company_city_name_required('City3')" maxlength=50>
</div>
<div class='sameline'>
<label for="state3">Eta:</label>
<select style="width: 125px;" name="state3" id="state3" size="1" >
<option value="">Chwazi yon eta..</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District Of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="GU">Guam</option>
<option value="PR">Puerto Rico</option>
<option value="VI">Virgin Islands</option>
</select>
</div>
<div class='sameline_zipcode'>
<label for="Zipcode3">Kòd Postal:</label>
<input size= "10" type="text" name="Zipcode3" id="Zipcode3" onchange="return check_company_zipcode('Zipcode3')" maxlength=10>
</div>
<div class='stack24'>
<label for="Telephone3">Nimewo Telefòn:</label>
<input size= "15" type="text" name="Telephone3" id="Telephone3" onchange="return check_company_telephone('Telephone3')" maxlength=15>
</div>
<div class='stack2'>
<label for="Narrative5">Bay dat (yo) ak lè ou kwè ou te viktim diskriminasyon oswa vanjans:</label>
<textarea class="nar5" rows="1" name="Narrative5" id="Narrative5" cols="60" onchange="return check_company_textarea_required('Narrative5')" ></textarea>
</div>
</div>
<!-----------------
Section 4
------------------>
<div class="column-left-4">
<h2>Pou kisa ou kwè patwon ou te fè diskriminasyon oswa vanjans kont ou?</h2>
</div>
<div class="column-right-4">
<!-----------------
Column 1
------------------>
<div class="sec4-col1">
<div class="spcdwn5">
<input value='1' id='Race40' name='Race40' type='checkbox' onkeypress="return button_on_or_off2(event,'Race40')">
<label for="Race40"><b>Ras</b></label>
</div>
<div class="spcdwn30">
<p class="indent">
<input value="1" id="Race41" name="Race41" type="checkbox" onkeypress="return button_on_or_off2(event,'Race41')">
<label class="basic2" for="Race41">Ameriken Natifnatal oswa Natifnatal Alaska</label>
</p>
</div>
<div class="spcdwn20">
<p class="indent">
<label class="basic2" for="Race4_Tribal_Affiliation4">Endike Afilyasyon Tribi a:</label>
<p class="indent2">
<input size= "10" type="text" name="Race4_Tribal_Affiliation4" id="Race4_Tribal_Affiliation4" maxlength=50>
</p>
</p>
</div>
<div class="spcdwn5">
<p class="indent">
<input value='1' id='Race42' name='Race42' type='checkbox' onkeypress="return button_on_or_off2(event,'Race42')">
<label class="basic2" for="Race42">Azyatik</label>
</p>
</div>
<div class="spcdwn5">
<p class="indent">
<input value='1' id='Race43' name='Race43' type='checkbox' onkeypress="return button_on_or_off2(event,'Race43')">
<label class="basic2" for="Race43">Moun Nwa oswa Ameriken Nwa</label>
</p>
</div>
<div class="offset01">
<p class="indent">
<input value='1' id='Race44' name='Race44' type='checkbox' onkeypress="return button_on_or_off2(event,'Race44')">
<label class="basic2" for="Race44">Natifnatal Zile Hawaii oswa Lòt Moun ki Fèt nan Zile Pasifik</label>
</p>
</div>
<div class="spcdwn5">
<p class="indent">
<input value='1' id='Race45' name='Race45' type='checkbox' onkeypress="return button_on_or_off2(event,'Race45')">
<label class="basic2" for="Race45">Moun Blan</label>
</p>
</div>
</div>
<!-----------------
Column 2
------------------>
<div class="sec4-col2">
<div class="spcdwn5">
<input value="1" id="National_Origin41" name="National_Origin41" type="checkbox" onkeypress="return button_on_or_off2(event,'National_Origin41')">
<label class="basic" for="National_Origin41"><b>Peyi kote Moun nan Fèt</b></label>
</div>
<div class="spcdwn10">
<p class="indent">
<input value="1" id="National_Origin411" name="National_Origin411" type="checkbox" onkeypress="return button_on_or_off2(event,'National_Origin411')">
<label class="basic2" for="National_Origin411">Ispanik oswa Latino-Ameriken</label>
</p>
</div>
<div class="spcdwn30">
<p class="indent">
<input value="1" id="National_Origin412" name="National_Origin412" type="checkbox" onkeypress="return button_on_or_off2(event,'National_Origin412')">
<label class="basic2" for="National_Origin412">Lòt</label>
</p>
</div>
<div class="field">
<input value="1" id="Color4" name="Color4" type="checkbox" onkeypress="return button_on_or_off2(event,'Color4')">
<label class="basic" for="Color4"><b>Koulè</b></label>
</div>
<div class="field">
<input value="1" id="Religion4" name="Religion4" type="checkbox" onkeypress="return button_on_or_off2(event,'Religion4')">
<label class="basic" for="Religion4"><b>Relijyon</b></label>
</div>
<div class="field">
<input value="1" id="Sex4" name="Sex4" type="checkbox" onkeypress="return button_on_or_off2(event,'Sex4')">
<label class="basic" for="Sex4"><b>Sèks</b></label>
</div>
</div>
<!-----------------
Column 3
------------------>
<div class="sec4-col3">
<div class="spcdwn5">
<input value="1" id="Sexual_Orientation4" name="Sexual_Orientation4" type="checkbox" onkeypress="return button_on_or_off2(event,'Sexual_Orientation4')">
<label class="basic" for="Sexual_Orientation4"><b>Preferans Seksyèl</b></label>
</div>
<div class="field">
<input value="1" id="Gender_Identity4" name="Gender_Identity4" type="checkbox" onkeypress="return button_on_or_off2(event,'Gender_Identity4')">
<label class="basic" for="Gender_Identity4"><b>Idantite Seksyèl</b></label>
</div>
<div class="field">
<input value="1" id="Inquiring_About_Pay4" name="Inquiring_About_Pay4" type="checkbox" onkeypress="return button_on_or_off2(event,'Inquiring_About_Pay4')">
<label class="basic" for="Inquiring_About_Pay4"><b>Demann Enfòmasyon Sou Salè</b></label>
</div>
<div class="field">
<input value="1" id="Discussing_Pay4" name="Discussing_Pay4" type="checkbox" onkeypress="return button_on_or_off2(event,'Discussing_Pay4')">
<label class="basic" for="Discussing_Pay4"><b>Diskisyon sou Salè</b></label>
</div>
<div class="field">
<input value="1" id="Disclosing_Pay4" name="Disclosing_Pay4" type="checkbox" onkeypress="return button_on_or_off2(event,'Disclosing_Pay4')">
<label class="basic" for="Disclosing_Pay4"><b>Divilgasyon Enfòmasyon sou Salè</b></label>
</div>
</div>
<!-----------------
Column 4
------------------>
<div class="sec4-col4">
<div class="offset02">
<input value="1" id="Protected_Veteran_Status4" name="Protected_Veteran_Status4" type="checkbox" onkeypress="return button_on_or_off2(event,'Protected_Veteran_Status4')">
<label class="basic" for="Protected_Veteran_Status4"><b>Kondisyon Veteran Pwoteje</b></label>
</div>
<div class="spcdwn5">
<input value="1" id="Disability4" name="Disability4" type="checkbox" onkeypress="return button_on_or_off2(event,'Disability4')">
<label class="basic" for="Disability4"><b>Andikap</b></label>
</div>
<div class="field">
<input value="1" id="Retaliation4" name="Retaliation4" type="checkbox" onkeypress="return button_on_or_off2(event,'Retaliation4')">
<label class="basic" for="Retaliation4"><b>Vanjans</b></label>
</div>
</div>
</div>
<!------------------------------------
SECTION 5
------------------------------------->
<div class="column-5">
<h2>Ki kote ou te aprann ou te kapab depoze yon plent ba OFCCP?</h2>
<div class="field_learn">
<input value="1" id="Complaint51" name="Complaint51" type="checkbox" onkeypress="return button_on_or_off2(event,'Complaint51')" >
<label for="Complaint51">Entènèt</label>
</div>
<div class="field_learn">
<input value="1" id="Complaint52" name="Complaint52" type="checkbox" onkeypress="return button_on_or_off2(event,'Complaint52')" >
<label for="Complaint52">Afich</label>
</div>
<div class="field_learn">
<input value="1" id="Complaint53" name="Complaint53" type="checkbox" onkeypress="return button_on_or_off2(event,'Complaint53')" >
<label for="Complaint53">Òganizasyon Kominotè</label>
</div>
<div class="field_learn">
<input value="1" id="Complaint54" name="Complaint54" type="checkbox" onkeypress="return button_on_or_off2(event,'Complaint54')" >
<label for="Complaint54">Reyinyon/Evènman OFCCP</label>
</div>
<div class="field_learn">
<input value="1" id="Complaint55" name="Complaint55" type="checkbox" onkeypress="return button_on_or_off2(event,'Complaint55')" >
<label for="Complaint55">Tiliv</label>
</div>
<div class="field_learn">
<input value="1" id="Complaint56" name="Complaint56" type="checkbox" onclick="return button_on_or_off2(event,'Complaint56')" onkeypress="return button_on_or_off2(event,'Complaint56')" >
<label for="Complaint56">Lòt</label>
</div>
</div>
<!------------------------------------
SECTION 6
------------------------------------->
<div class="column-6">
<h2>Plent Ou:</h2>
<p class="spcdwnup"><b>Tanpri dekri anba la a sa ou panse patwon ou te fè oswa pa t fè epi ou kwè sa te lakòz ou viktim diskriminasyon oswa vanjans, tankou:</b></p>
<div class="stack">
<ol>
<li>Kisa aksyon patwon an te fè kont ou.</li>
<li>Pou kisa ou kwè aksyon yo te baze sou: ras ou; koulè ou; relijyon ou; sèks ou; preferans seksyèl ou; idantite seksyèl ou; peyi kote ou soti; andikap ou; kondisyon veteran ou; ak/oswa rechèch, diskisyon, divilgasyon enfòmasyon sou salè ou oswa salè lòt moun; epi/oswa nan vanjans pou depoze yon plent, patisipasyon nan pwosedi diskriminasyon, opozisyon nan diskriminasyon ilegal, oswa egzèsis nenpòt lòt dwa ki pwoteje avèk OFCCP.</li>
<li>Kilè patwon an te fè aksyon yo, kote aksyon yo te fèt, epi kimoun ki te konsène.</li>
<li>Ki domaj, si genyen, oumenm oswa lòt moun te soufri akòz diskriminasyon oswa vanjans ou sipoze a.</li>
<li>Ki eksplikasyon, si genyen, patwon ou oswa moun ki reprezante patwon ou te ofri pou aksyon yo.</li>
<li>Kimoun ki te nan menm sitiyasyon an oswa sitiyasyon sanblab tankou oumenm ak fason yo te trete. Mete enfòmasyon tankou ras, koulè, relijyon, sèks, preferans seksyèl, idantite seksyèl, peyi kote ou soti, andikap, oswa kondisyon pwoteje moun sa yo, si ou konnen yo.</li>
<li>Ki enfòmasyon ou genyen sou kontra federal konpayi kote ou t ap travay la te genyen nan moman diskriminasyon oswa vanjans ou dekri nan plent sa a.</li>
</ol>
</div>
<div class="stack_nar6">
<label for="Narrative6" class="scrn-rdr">Atansyon</label>
<textarea class="nar6" rows="4" name="Narrative6" id="Narrative6" cols="60" onchange="return check_textarea_required('Narrative6')" ></textarea>
</div>
</div>
<!------------------------------------
SECTION 7
------------------------------------->
<div class="column-left-7">
<h2>Èske ou panse diskriminasyon an gen lòt moun ladan oswa afekte lòt moun?</h2>
</div>
<div class="column-right-7">
<p class="spcdwn">Èske ou kwè lòt anplwaye yo oswa moun ki aplike yo te trete menm fason jan ou te dekri anwo a?</p>
<div class="sameline">
<input value="1" id="Treated5" name="Treated5" type="checkbox" onclick="return mouse_on_or_off('Treated5','Treated6')" onkeypress="return button_on_or_off(event,'Treated5','Treated6')">
<label for="Treated5">Wi</label>
<input value="2" id="Treated6" name="Treated5" type="checkbox" onclick="return mouse_on_or_off('Treated6','Treated5')" onkeypress="return button_on_or_off(event,'Treated6','Treated5')">
<label for="Treated6">Non</label>
</div>
</div>
<!------------------------------------
SECTION 8
------------------------------------->
<div class="column-left-8" >
<h2>Èske ou gen yon avoka oswa lòt reprezantan?</h2>
</div>
<div class="column-right-8" >
<p class="spcdwn">Si ou gen reprezantasyon yon avoka, oswa yon lòt moun, oswa yon òganizasyon, tanpri bay enfòmasyon pou kontakte yo anba la a.</p>
<div class='stack'>
<label for="Fullname21">Nonn (Prenon, Dezyèm Prenon, Non Fanmi):</label>
<input size= "35" type="text" name="Fullname21" id="Fullname21" onchange="return check_attorney_name('Fullname21')" maxlength=50>
</div>
<div class='stack'>
<label for="Address21">Nimewo Kay: </label>
<input size= "50" type="text" name="Address21" id="Address21" onchange="return check_attorney_address('Address21')" maxlength=50>
</div>
<div class='stack4'>
<label for="City21">Vil:</label>
<input size= "50" type="text" name="City21" id="City21" onchange="return check_attorney_city_name('City21')" maxlength=50>
</div>
<div class='sameline'>
<label for="state21">Eta:</label>
<select style="width: 125px;" name="state21" id="state21" size="1" >
<option value="">Chwazi yon eta..</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District Of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
<option value="GU">Guam</option>
<option value="PR">Puerto Rico</option>
<option value="VI">Virgin Islands</option>
</select>
</div>
<div class='sameline_zipcode'>
<label for="Zipcode21">Kòd Postal:</label>
<input size= "10" type="text" name="Zipcode21" id="Zipcode21" onchange="return check_attorney_zipcode('Zipcode21')" maxlength=10>
</div>
<div class='stack24'>
<label for="Telephone21">Nimewo Telefòn:</label>
<input size= "15" type="text" name="Telephone21" id="Telephone21" onchange="check_attorney_telephone('Telephone21')" maxlength=15>
</div>
<div class='stack'>
<label for="Email21">Adrès Imèl:</label>
<input type="text" size=60 onchange="return check_attorney_email('Email21')" name="Email21" id="Email21" maxlength=60>
</div>
<div class='stack'>
<p class="spcdwnup" >Kimoun nou ta dwe kontakte si nou bezwen plis enfòmasyon sou deskripsyon sa ki te pase a?</p>
</div>
<div class='sameline'>
<input value="1" id="Attorney5_You" name="Attorney5" type="checkbox" onkeypress="return button_on_or_off(event,'Attorney5_You','Attorney6_You')" onclick="return mouse_on_or_off('Attorney5_You','Attorney6_You')">
<label for="Attorney5_You">Oumenm</label>
<input value="2" id="Attorney6_You" name="Attorney5" type="checkbox" onkeypress="return button_on_or_off(event,'Attorney6_You','Attorney5_You')" onclick="return mouse_on_or_off('Attorney6_You','Attorney5_You')">
<label for="Attorney6_You">Reprezantan Ou</label>
</div>
</div>
<!------------------------------------
SECTION 9
------------------------------------->
<div class="column-left-9">
<h2>Siyati ak Verifikasyon</h2>
</div>
<div class="column-right-9">
<p class="spcdwn">Mwen deklare, anba menas sanksyon pou fo temwayaj, enfòmasyon mwen bay yo se enfòmasyon ki vrè dapre tout sa mwen konnen. Lalwa ap pini mwen si mwen fè espre pou bay fo temwayaj.</p>
<p class="spcdwn">Mwen bay otorizasyon pou yo divilge nenpòt enfòmasyon medikal ki nesesè pou ankèt sa a.</p>
<div class="sameline">
<label for="Print_Signature">Siyati Moun ki Fè Plent lan:</label>
<input size= "20" type="text" name="Print_Signature" id="Print_Signature" onchange="check_signature_required('Print_Signature')" maxlength=20>
</div>
<div class="sameline">
<label for="Print_Signature_Date">Dat la:</label>
<input size= "20" type="text" name="Print_Signature_Date" id="Print_Signature_Date" onfocus="check_date_required('Print_Signature_Date')">
</div>
</div>
<!------------------------------------
Foot
------------------------------------->
<div class="column-span-revised">
<p class="title_bottom">Fòm CC-4 (Revize 5/2017)</p>
</div>
<!------------------------------------
Submit
------------------------------------->
<div class="column-span-submit">
<button class="right" onclick="return validateForm()">Soumèt</button>
</div>
</form>
</div>
</div>
</body>
</html>