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<!DOCTYPE html>
<html lang="zh-Hans">
<head>
<title>OFCCP 投诉表 Chinese Simplified</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
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<link rel="stylesheet" type="text/css" media="screen" href="dol_screen_chinese_simplified.css">
<link rel="stylesheet" type="text/css" media="screen and (max-width: 778px)" href="ipad_chinese_simplified.css">
<link rel="stylesheet" type="text/css" media="screen and (max-width: 635px)" href="iphone_chinese_simplified.css">
<script src="dol_style_chinese_simplified.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">跳到主要内容</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" >涉及联邦政府承包商或分包商的就业歧视投诉</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="Chinese-Simplified">
<input type="hidden" name="Instructions" id="Instructions" value="Show">
<div class="read_instructions" id="read_instructions">
<a href="javascript:instructions();">投诉表格说明</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="Chinese-Simplified">
<div class="top-2-left" >
<p>OMB: 1250-0002</p>
<p>有效期: 5/31/2020</p>
</div>
<div class="top-2-right" >
<input class="button_exec" id="button_exec" type="button" onclick="return clear_form()" value="重置表单">
<input class="button_exec" id="button_exec" type="button" onclick="return print_form()" value="打印表单">
<input class="button_exec" id="button_exec" type="button" onclick="return validateForm()" value="提交">
</div>
<!------------------------------------
SECTION 1
------------------------------------->
<div class="column-left-1">
<h2 id="maincontent" tabindex="-1">我们如何与您联系？</h2>
</div>
<div class="column-right-1">
<div class='stack'>
<label for="Fullname1">姓名（名，中间名，姓氏）：</label>
<input size="20" type="text" name="Fullname1" id="Fullname1" onchange="return check_name_required('Fullname1')" maxlength=50>
</div>
<div class='stack'>
<label for="Address1">街道地址:</label>
<input size= "30" type="text" name="Address1" id="Address1" onchange="return check_address_required('Address1')" maxlength=50>
</div>
<div class='stack4'>
<label for="City1">城市:</label>
<input size= "30" type="text" name="City1" id="City1" onchange="return check_city_name_required('City1')" maxlength=50>
</div>
<div class='sameline'>
<label for="state1">州:</label>
<select style="width: 125px;" name="state1" id="state1" size="1" onchange="return check_state_required('state1')">
<option value="">州?...</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">邮政编码:</label>
<input size= "5" type="text" name="Zipcode1" id="Zipcode1" onchange="return check_zipcode('Zipcode1')" maxlength=10>
</div>
<div class='stack24'>
<label for="Telephone1">电话号码:</label>
<input size= "10" 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">宅电</label>
<input value="2" id="Work1" name="Telephone_type1" type="checkbox" onkeypress="return button_on_or_off2(event,'Work1')" >
<label for="Work1">工作电话</label>
<input value="3" id="Cell1" name="Telephone_type1" type="checkbox" onkeypress="return button_on_or_off2(event,'Cell1')" >
<label for="Cell1">手机</label>
</div>
<div class='stack'>
<label for="Email1">电子邮件: </label>
<input type="text" size=30 onchange="return check_email('Email1')" name="Email1" id="Email1" maxlength=60>
</div>
<div class='stack'>
<p class="spcdwnup">您是否已经向另一个联邦或地方机构提交了这些有关就业歧视的指控？</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">是</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">否</label>
</div>
<div class='stack'>
<label for="Agency_Name1">如果是，哪个机构:</label>
<input size= "20" 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">联系人姓名：</label>
<input size="10" 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">电话号码：</label>
<input size="10" 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>如果我们无法与您联系，我们联系谁？</h2>
</div>
<div class="column-right-2" >
<div class='stack'>
<label for="Fullname2">姓名（名，中间名，姓氏）：</label>
<input size= "20" type="text" name="Fullname2" id="Fullname2" onchange="return check_contact_name('Fullname2')" maxlength=50>
</div>
<div class='stack'>
<label for="Address2">街道地址:</label>
<input size= "30" type="text" name="Address2" id="Address2" onchange="return check_contact_address('Address2')" maxlength=50>
</div>
<div class='stack4'>
<label for="City2">城市:</label>
<input bgcolor="#3CBC8D" size= "30" type="text" name="City2" id="City2" onchange="return check_contact_city_name('City2')" maxlength=50>
</div>
<div class='sameline'>
<label for="state2">州:</label>
<select style="width: 125px;" name="state2" id="state2" size="1">
<option value="">州?...</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">邮政编码:</label>
<input size= "5" type="text" name="Zipcode2" id="Zipcode2" onchange="return check_contact_zipcode('Zipcode2')" maxlength=10>
</div>
<div class='stack24'>
<label for="Telephone2">电话号码:</label>
<input size= "10" 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">宅电</label>
<input value="2" id="Work2" name="Telephone_type2" type="checkbox" onkeypress="return button_on_or_off2(event,'Work2')" >
<label for="Work2">工作电话</label>
<input value="3" id="Cell2" name="Telephone_type2" type="checkbox" onkeypress="return button_on_or_off2(event,'Cell2')" >
<label for="Cell2">手机</label>
</div>
<div class='stack'>
<label for="Email2">电子邮件: </label>
<input type="text" id="Email2" name="Email2" size=30 onchange="return check_contact_email('Email2')" maxlength=60>
</div>
</div>
<!------------------------------------
SECTION 3
------------------------------------->
<div class="column-left-3">
<h2>您认为歧视或报复您的雇主的名字是什么？</h2>
</div>
<div class="column-right-3">
<div class='stack'>
<label for="Fullname3">公司名称:</label>
<input size= "20" type="text" name="Fullname3" id="Fullname3" onchange="return check_company_name_required('Fullname3')" maxlength=50>
</div>
<div class='stack'>
<label for="Address3">街道地址:</label>
<input size= "30" type="text" name="Address3" id="Address3" onchange="return check_company_address_required('Address3')" maxlength=50>
</div>
<div class='stack4'>
<label for="City3">城市:</label>
<input size= "30" type="text" name="City3" id="City3" onchange="return check_company_city_name_required('City3')" maxlength=50>
</div>
<div class='sameline'>
<label for="state3">州:</label>
<select style="width: 125px;" name="state3" id="state3" size="1" >
<option value="">州?...</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">邮政编码:</label>
<input size= "5" type="text" name="Zipcode3" id="Zipcode3" onchange="return check_company_zipcode('Zipcode3')" maxlength=10>
</div>
<div class='stack24'>
<label for="Telephone3">电话号码:</label>
<input size= "10" type="text" name="Telephone3" id="Telephone3" onchange="return check_company_telephone('Telephone3')" maxlength=15>
</div>
<div class='stack2'>
<label for="Narrative5">提供您认为您受到歧视或报复的日期和时间：</label>
<textarea class="nar5" rows="1" 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>您为什么认为您的雇主对您有歧视或报复？</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>种族</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">美国印第安人或阿拉斯加原住民</label>
</p>
</div>
<div class="spcdwn20">
<p class="indent">
<label class="basic2" for="Race4_Tribal_Affiliation4">表明部落关系:</label>
<p class="indent2">
<input size= "5" 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">亚裔</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">黑人或非裔美国人</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">夏威夷原住民或其他太平洋岛民</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">白人</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>国籍</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">西班牙裔或拉丁裔</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">其他</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>膚色</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>宗教</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>性别</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>性取向</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>性别认同</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>查询付款</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>讨论付款</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>披露付款</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>受保护的退伍军人身份</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>残疾</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>报复</b></label>
</div>
</div>
</div>
<!------------------------------------
SECTION 5
------------------------------------->
<div class="column-5">
<h2>您在哪里得知您可以向OFCCP提出投诉？</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">互联网</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">海报</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">社区组织</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">OFCCP 会议/活动</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">手册</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">其他</label>
</div>
</div>
<!------------------------------------
SECTION 6
------------------------------------->
<div class="column-6">
<h2>您的投诉：</h2>
<p class="spcdwnup"><b>请在下面描述您认为雇主从事或未从事您认为造成歧视或报复的行为，包括：</b></p>
<div class="stack">
<ol>
<li>雇主对你采取了什么行动。</li>
<li>为什么你认为这些行动是基于你的：种族;肤色;宗教;性别;性取向;性别认同;国籍;残疾;退伍状态;和/或查询、讨论或披露您的薪酬或他人的薪酬;和/或报复投诉、参与歧视诉讼、反对非法歧视或行使OFCCP保护的任何其他权利。</li>
<li>雇主行动发生的时间、地点以及涉事人员。</li>
<li>如果有的话，您或其他人因指称的歧视或报复而受到伤害。</li>
<li>如果有的话，您的雇主或代表您雇主的人为他们的行动作何解释。</li>
<li>谁是与你的情况相同或相似，他们是如何被对待的。包括种族、肤色、宗教、性别、性取向、性别认同、国籍、残疾或这些人的受保护身份（如果知道的话）的信息。</li>
<li>您在本投诉中描述的歧视或报复之时，有关您工作所在公司的联邦合同的信息。</li>
</ol>
</div>
<div class="stack_nar6">
<label for="Narrative6" class="scrn-rdr">注意</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>你认为歧视包括或影响他人吗？</h2>
</div>
<div class="column-right-7">
<p class="spcdwn">您认为其他员工或申请人是否按照上述方式处理吗？</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">是</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">否</label>
</div>
</div>
<!------------------------------------
SECTION 8
------------------------------------->
<div class="column-left-8" >
<h2>你有律师或其他代表吗？</h2>
</div>
<div class="column-right-8" >
<p class="spcdwn">如果您由律师，其他人或组织代表，请在下面提供他们的联系信息。</p>
<div class='stack'>
<label for="Fullname21">姓名（名，中间名，姓氏）：</label>
<input size= "20" type="text" name="Fullname21" id="Fullname21" onchange="return check_attorney_name('Fullname21')" maxlength=50>
</div>
<div class='stack'>
<label for="Address21">街道地址:</label>
<input size= "30" type="text" name="Address21" id="Address21" onchange="return check_attorney_address('Address21')" maxlength=50>
</div>
<div class='stack4'>
<label for="City21">城市:</label>
<input size= "30" type="text" name="City21" id="City21" onchange="return check_attorney_city_name('City21')" maxlength=50>
</div>
<div class='sameline'>
<label for="state21">州:</label>
<select style="width: 125px;" name="state21" id="state21" size="1" >
<option value="">州?...</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">邮政编码:</label>
<input size= "5" type="text" name="Zipcode21" id="Zipcode21" onchange="return check_attorney_zipcode('Zipcode21')" maxlength=10>
</div>
<div class='stack24'>
<label for="Telephone21">电话号码:</label>
<input size= "10" type="text" name="Telephone21" id="Telephone21" onchange="check_attorney_telephone('Telephone21')" maxlength=15>
</div>
<div class='stack'>
<label for="Email21">电子邮件:</label>
<input type="text" size=30 onchange="return check_attorney_email('Email21')" name="Email21" id="Email21" maxlength=60>
</div>
<div class='stack'>
<p class="spcdwnup">如果我們需要更多關於您所發生情況的描述的更多資訊，我們應該联络誰？</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">您本人</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">您的代表</label>
</div>
</div>
<!------------------------------------
SECTION 9
------------------------------------->
<div class="column-left-9">
<h2>签名和验证</h2>
</div>
<div class="column-right-9">
<p class="spcdwn">本人声明，根据本人所知所信，以上提供的信息真实且正确。故意的虚假陈述应受法律惩罚。</p>
<p class="spcdwn">本人在此授权发布本次调查所需的任何医疗信息。
</p>
<div class="sameline">
<label for="Print_Signature">投诉人签名:</label>
<input size= "5" 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">日期:</label>
<input size= "10" 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">表格 CC-4 (修订于 5/2017)</p>
</div>
<!------------------------------------
Submit
------------------------------------->
<div class="column-span-submit">
<button class="right" onclick="return validateForm()">提交</button>
</div>
</form>
</div>
</div>
</body>
</html>