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<!DOCTYPE html>
<html lang="en">
<head>
<title>OFCCP Daim Ntawv Foos Hais Qhov Tsis Txaus Siab Hmong</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_hmong.css">
<link rel="stylesheet" type="text/css" media="screen and (max-width: 778px)" href="ipad_hmong.css">
<link rel="stylesheet" type="text/css" media="screen and (max-width: 635px)" href="iphone_hmong.css">
<script src="dol_style_hmong.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">Hla mus rau Lub Hauv Paus Ntsiab Lus</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">Kev Tsis Txaus Siab Txuam Kev Ntxub Ntxaug Fab Hauj Lwm ntawm Lub Lag Luam Cog Lus los yog Ceg Lag Luam Cog Lus Nrog Tsoom Fwv</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="Hmong">
<input type="hidden" name="Instructions" id="Instructions" value="Show">
<div class="read_instructions" id="read_instructions">
<a href="javascript:instructions();">Thov nyeem cov lus qhia teb ua ntej teb tsab ntawv no.</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="Hmong">
<div class="top-2-left" >
<p>OMB: 1250-0002</p>
<p>Hnub Tas Sij Hawm: 5/31/2020</p>
</div>
<div class="top-2-right" >
<input class="button_exec" id="button_exec" type="button" onclick="return clear_form()" value="Rov Teeb">
<input class="button_exec" id="button_exec" type="button" onclick="return print_form()" value="Luam">
<input class="button_exec" id="button_exec" type="button" onclick="return validateForm()" value="Xa">
</div>
<!------------------------------------
SECTION 1
------------------------------------->
<div class="column-left-1">
<h2 id="maincontent" tabindex="-1">Peb yuav cuag koj tau li cas?</h2>
</div>
<div class="column-right-1">
<div class='stack'>
<label for="Fullname1">Npe (Npe, Npe Nruab Nrab, Xeem):</label>
<input size="45" type="text" name="Fullname1" id="Fullname1" onchange="return check_name_required('Fullname1')" maxlength=50>
</div>
<div class='stack'>
<label for="Address1">Chaw Nyob:</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">Zos:</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">Xeev:</label>
<select style="width: 125px;" name="state1" id="state1" size="1" onchange="return check_state_required('state1')">
<option value="">Xeev?....</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">Zauv Cim Cheeb Tsam:</label>
<input size= "10" type="text" name="Zipcode1" id="Zipcode1" onchange="return check_zipcode('Zipcode1')" maxlength=10>
</div>
<div class='stack24'>
<label for="Telephone1">Xov Tooj:</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">Tsev</label>
<input value="2" id="Work1" name="Telephone_type1" type="checkbox" onkeypress="return button_on_or_off2(event,'Work1')" >
<label for="Work1">Hauj Lwm</label>
<input value="3" id="Cell1" name="Telephone_type1" type="checkbox" onkeypress="return button_on_or_off2(event,'Cell1')" >
<label for="Cell1">Cev</label>
</div>
<div class='stack'>
<label for="Email1">Chaw xa ntawv E-mail: </label>
<input type="text" size=55 onchange="return check_email('Email1')" name="Email1" id="Email1" maxlength=60>
</div>
<div class='stack'>
<p class="spcdwnup">Koj puas tau ua cov lus iab liam txog chaw hauj lwm kev ntxub ntxaug no nrog lwm lub chaw khiav dej num rau tsoom fwv teb chaws los yog rau xeev dhau los?</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">Tau</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">Tsis tau</label>
</div>
<div class='stack24'>
<label for="Agency_Name1">Yog tau, lub chaw khiav dej num twg:</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">Tus Neeg Hu Cuag Tau Npe:</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">Xov Tooj:</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>Peb hu tau rau leej twg yog peb hu tsis tau koj?</h2>
</div>
<div class="column-right-2" >
<div class='stack'>
<label for="Fullname2">Npe (Npe, Npe Nruab Nrab, Xeem):</label>
<input size= "45" type="text" name="Fullname2" id="Fullname2" onchange="return check_contact_name('Fullname2')" maxlength=50>
</div>
<div class='stack'>
<label for="Address2">Chaw Nyob:</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">Zos:</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">Xeev:</label>
<select style="width: 125px;" name="state2" id="state2" size="1" >
<option value="">Xeev?....</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">Zauv Cim Cheeb Tsam:</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">Xov Tooj:</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">Tsev</label>
<input value="2" id="Work2" name="Telephone_type2" type="checkbox" onkeypress="return button_on_or_off2(event,'Work2')" >
<label for="Work2">Hauj Lwm</label>
<input value="3" id="Cell2" name="Telephone_type2" type="checkbox" onkeypress="return button_on_or_off2(event,'Cell2')" >
<label for="Cell2">Cev</label>
</div>
<div class='stack'>
<label for="Email2">Chaw xa ntawv E-mail: </label>
<input type="text" id="Email2" name="Email2" size=55 onchange="return check_contact_email('Email2')" maxlength=60>
</div>
</div>
<!------------------------------------
SECTION 3
------------------------------------->
<div class="column-left-3">
<h2>Lub chaw hauj lwm npe uas koj ntseeg tias tau ntxub ntxaug los yog tawm tsam koj?</h2>
</div>
<div class="column-right-3">
<div class='stack'>
<label for="Fullname3">Lag Luam Npe:</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">Chaw Nyob:</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">Zos:</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">Xeev:</label>
<select style="width: 125px;" name="state3" id="state3" size="1" >
<option value="">Xeev?....</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">Zauv Cim Cheeb Tsam:</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">Xov Tooj:</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">Qhia (cov) hnub thiab sij hawm uas koj ntseeg tias koj tau raug kev ntxub ntxaug los yog kev tawm tsam:</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>Vim li cas koj thiaj ntseeg hais tias lub hauj lwm ntxub ntxaug los yog tawm tsam koj?</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>Haiv neeg</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">Neeg Asmeskas Qhab los yog Neeg Xeeb Txawm Alaska</label>
</p>
</div>
<div class="spcdwn20">
<p class="indent">
<label class="basic2" for="Race4_Tribal_Affiliation4">Qhia Pab pawg neeg koom:</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">Neeg Esxias</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">Neeg Dub los yog Neeg Asmeskas Dub</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">Neeg Xeeb Txawm Hawaii los yog lwm cov Neeg Pov Txwv Pacific</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">Neeg Dawb</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>Yug Txawv Teb Chaws</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">Neeg Mev Hispanic los yog Latino</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">Lwm yam</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>Xim nqaij daim tawv</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>Kev ntseeg</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>Zeej xeeb</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>Kev yeem sib dee</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>Kev Zeej Xeeb</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>Nug Txog Them Nyiaj Li Cas</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>Sib Tham Txog Kev Them Nyiaj</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>Qhia Tawm Nyiaj Them</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>Qub Tub Rog Qib Tiv Thaiv</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>Kev tsis taus</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>Kev tawm tsam</b></label>
</div>
</div>
</div>
<!------------------------------------
SECTION 5
------------------------------------->
<div class="column-5">
<h2>Thaum twg koj paub txog hais tias koj ua tau tsab ntawv teev kev tsis txaus siab rau OFCCP?</h2>
<div class="field_learn">
<input value="1" id="Complaint51" name="Complaint51" type="checkbox" onkeypress="return button_on_or_off2(event,'Complaint51')" >
<label class="field_learn" for="Complaint51">Internet</label>
</div>
<div class="field_learn">
<input value="1" id="Complaint52" name="Complaint52" type="checkbox" onkeypress="return button_on_or_off2(event,'Complaint52')" >
<label class="field_learn" for="Complaint52">Duab Tshaj Qhia</label>
</div>
<div class="field_learn">
<input value="1" id="Complaint53" name="Complaint53" type="checkbox" onkeypress="return button_on_or_off2(event,'Complaint53')" >
<label class="field_learn" for="Complaint53">Koom Haum Hauv Zej Zog</label>
</div>
<div class="field_learn">
<input value="1" id="Complaint54" name="Complaint54" type="checkbox" onkeypress="return button_on_or_off2(event,'Complaint54')" >
<label class="field_learn" for="Complaint54">OFCCP Rooj Sib Tham/Koom Txoos</label>
</div>
<div class="field_learn">
<input value="1" id="Complaint55" name="Complaint55" type="checkbox" onkeypress="return button_on_or_off2(event,'Complaint55')" >
<label class="field_learn" for="Complaint55">Phau Ntawv Qhia</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 class="field_learn" for="Complaint56">Lwm Yam</label>
</div>
</div>
<!------------------------------------
SECTION 6
------------------------------------->
<div class="column-6">
<h2>Koj Cov Lus Tsis Txaus Siab:</h2>
<p class="spcdwnup"><b>Thov piav rau nram no txog yam koj xav tias lub chaw hauj lwm tau ua los yog tau tsis ua uas koj ntseeg tias tsim muaj txoj kev ntxub ntxaug los yog kev tawm tsam, nrog rau:</b></p>
<div class="stack">
<ol>
<li>Cov yam ntxwv ua lub chaw hauj lwm tau coj rau koj.</li>
<li>Vim li cas koj thiaj ntseeg tias cov yam ntxwv ntawd yog tim koj: haiv neeg; xim nqaij daim tawv; kev ntseeg; zeej xeeb; kev yeem sib deev; poj niam los txiv neej; yug txawv teb chaws, kev tsis taus, qib qub tub rog; thiab/los yog cov lus nug txog, cov lus sib tham, los yog cov kev qhia tawm qhov nyiaj them koj los yog them lwm cov; thiab/los yog muaj kev tawm tsam vim ua tsab ntawv tsis txaus siab, koom nrog cov txheej txheem lis kev ntxub ntxaug, txwv txiav tsis kheev muaj kev ntxub ntxaug txhaum cai, los yog ua raws li lwm cov cai uas tiv thaiv los ntawm OFCCP.</li>
<li>Thaum twg, qhov twg thiab leej twg ntxuam nrog cov yam ntxwv tshwm sim hauv lub hauj lwm.</li>
<li>Yog tias muaj, tsim muaj cov kev mob li cas raug koj los yog raug lwm cov neeg vim los ntawm txoj kev ntxub ntxaug los yog kev tawm tsam.</li>
<li>Yog tias muaj, koj lub hauj lwm los yog cov neeg sawv cev nres koj lub hauj lwm puas tau muab cov lus piav qhia dab tsi li cas txog lawv cov yam ntxwv coj.</li>
<li>Leej twg raug tib yam los yog teeb meem zoo xws li koj raug thiab coj li cas rau lawv.Qhia cov ncauj lus xws li haiv neeg, xim nqaij daim tawv, kev ntseeg, zej xeeb, kev yeem sib deev, poj niam los yog txiv neej, yog txawv teb chaws, kev tsis taus, qib tiv thaiv rau cov ib neeg no, yog tias paub.</li>
<li>Koj muaj cov ncauj lus twg txog tsoom fwv cov kev cog ua lag luam nrog lub lag luam uas koj ua hauj lwm rau thaum lub sij hawm muaj qhov kev ntxub ntxaug los yog kev tawm tsam uas koj piav hauv tsab ntawv teev kev tsis txaus siab no.</li>
</ol>
</div>
<div class="stack_nar6">
<label for="Narrative6" class="scrn-rdr">Nco tseg</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>Koj puas xav tias txoj kev ntxub ntxaug puas txog los yog muaj feem xyuam lwm cov neeg?</h2>
</div>
<div class="column-right-7">
<p class="spcdwn">Koj puas ntseeg tias lwm cov neeg ua hauj lwm los yog neeg ua ntawv thov hauj lwm raug tib cov kev raws li koj piav saum no?</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">Ntseeg</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">Tsis Ntseeg</label>
</div>
</div>
<!------------------------------------
SECTION 8
------------------------------------->
<div class="column-left-8" >
<h2>Koj puas muaj tus kws lij choj los yog lwm tus neeg sawv nres koj?</h2>
</div>
<div class="column-right-8" >
<p class="spcdwn">Yog koj muaj tus kws lij choj los yog lwm tus neeg los yog ib lub koom haum sawv cev nres koj, thov qhia kev hu cuag tau lawv rau nram no:</p>
<div class='stack'>
<label for="Fullname21">Npe (Npe, Npe Nruab Nrab, Xeem):</label>
<input size= "45" type="text" name="Fullname21" id="Fullname21" onchange="return check_attorney_name('Fullname21')" maxlength=50>
</div>
<div class='stack'>
<label for="Address21">Chaw Nyob:</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">Zos:</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">Xeev:</label>
<select style="width: 125px;" name="state21" id="state21" size="1" >
<option value="">Xeev?....</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">Zauv Cim Cheeb Tsam:</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">Xov Tooj:</label>
<input size= "15" type="text" name="Telephone21" id="Telephone21" onchange="check_attorney_telephone('Telephone21')" maxlength=15>
</div>
<div class='stack'>
<label for="Email21">Chaw Xa Ntawv E-mail:</label>
<input type="text" size=55 onchange="return check_attorney_email('Email21')" name="Email21" id="Email21" maxlength=60>
</div>
<div class='stack'>
<p class="spcdwnup" >Peb hu cuag tau leej twg yog peb xav paub ntxiv txog cov lus koj piav yam tau tshwm sim ntawd?</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">Koj</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">Tus Neeg Sawv Nres Koj</label>
</div>
</div>
<!------------------------------------
SECTION 9
------------------------------------->
<div class="column-left-9">
<h2>Kos Npe thiab Kev Txheeb Meej</h2>
</div>
<div class="column-right-9">
<p class="spcdwn">Kuv qhia raws txoj cai tias cov ncauj lus sau saum no muaj tseeb thiab yog raws li kuv muaj peev xwm paub los yog ntseeg tau.Nqe lus dag yuav raug txim raws txoj cai.</p>
<p class="spcdwn">Ntawm no kuv tso cai kev qhia tawm txhua yam ntaub ntawv teev kab mob kev nkeg uas yuav tsum tau muaj rau txoj kev tshawb fawb no.
</p>
<div class="sameline">
<label for="Print_Signature">Neeg Tsis Txaus Siab Kos Npe:</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">Hnub tim:</label>
<input size= "15" 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">Tsab Ntawv CC-4 (kho tshia 5/2017)</p>
</div>
<!------------------------------------
Submit
------------------------------------->
<div class="column-span-submit">
<button class="right" onclick="return validateForm()">Xa</button>
</div>
</form>
</div>
</div>
</body>
</html>