How to Fill Out EEOC Form 283

EEOC Form 283 at a glance

What it is: EEOC Form 283, Intake Questionnaire, March 1984, is where you tell the EEOC briefly why you have been discriminated against in employment.

Who signs: Sign on the SIGNATURE line and enter the DATE.

You complete this form, telling the EEOC briefly why you have been discriminated against in employment.

A filled-in EEOC Form 283 example: a job applicant fills out the questionnaire

EEOC Form 283 example filled out, example: a job applicant fills out the questionnaire
Dana Sample, a job applicant, fills out EEOC Form 283. A company with about 200 employees did not hire her, and she believes her age was the reason. The picture shows page 1 only, and none of its entries is real. She checks only AGE in Because of: race, sex, age, religion or color, so OTHER, EXPLAIN BRIEFLY stays empty. She names one employer in Who discriminated against you, so the second name block stays empty. She checks EMPLOYER there, so UNION stays empty. She applied for the job and never worked there, so the other lines in Are you now employed by the Employer stay empty. She checks CONSENT, so NOT CONSENT stays empty in Consent to disclosure. She checks No for help sought and for an earlier charge, so Yes and the lines after it stay empty in Assistance and EEOC Charge in the past.

How to fill out EEOC Form 283, box by box

Your name, address and the date

EEOC Form 283 example filled out, your name, address and the date

Please print your name as First, Middle name or initial and Last, with the date, your address, telephone, city, state, zip code and county.

The action taken against you

EEOC Form 283 example filled out, the action taken against you

What action was taken against you that you believe to be discriminatory, and what harm, if any, was caused to you or others in your work situation as a result of that action? If more space is required, use page 2.

Because of: race, sex, age, religion or color

EEOC Form 283 example filled out, because of: race, sex, age, religion or color

Check the one(s) that apply and specify your race, sex, age, religion or ethnic identity: race, sex, religion, national origin, age, retaliation, color, or other, explain briefly.

Who discriminated against you

EEOC Form 283 example filled out, who discriminated against you

Check the one(s) that apply: EMPLOYER, UNION, EMPLOYMENT AGENCY or OTHER (Specify).

Enter NAME, ADDRESS and CITY, STATE, ZIP CODE.

Enter the APPROXIMATE NUMBER EMPLOYED BY THIS EMPLOYER and the most recent date the harm you alleged took place.

Are you now employed by the Employer

EEOC Form 283 example filled out, are you now employed by the Employer

Are you now employed by the Employer that harmed you? Yes: From (Date) and Current Position. No: I Applied for (Position) on (Date), or: I was employed as (Position) until I was.

Assistance and EEOC Charge in the past

EEOC Form 283 example filled out, assistance and EEOC Charge in the past

Have you sought assistance about the action you think was discriminatory from any Government agency, from your union, an attorney, or from any other source? Check No or Yes. If the answer is yes, complete the name of source of assistance, the date and the result, if any.

Have you filed an EEOC Charge in the past? Check No or Yes. If the answer is yes, complete the approximate date filed, the organization charged and the charge number (if known).

Signing the form

EEOC Form 283 example filled out, signing the form

Sign on the SIGNATURE line and enter the DATE.

More rules for EEOC Form 283

An officer of the EEOC will talk with you after you complete this form.

The providing of this information is voluntary but the failure to do so may hamper the Commission's processing of a charge of discrimination. It is not mandatory that this form be used to provide the requested information.

See the Privacy Act Statement on page 2 before completing this form.

Sources

[1] EEOC Form 283, Intake Questionnaire (served file; no issuer file found) (the Official source link on this page).

Eeoc Form 283 PDF Details

Filling out the EEOC Form 283, also known as the Intake Questionnaire, is a critical step for individuals who believe they have faced discrimination in the workplace. Protected under the Privacy Act of 1974, this form requires candid responses from the complainant regarding the nature of the alleged discrimination, including details such as the name of the person filling out the form, contact information, and specific allegations of discrimination based on race, sex, religion, national origin, age, retaliation, color, or other specified reasons. It asks individuals to clearly outline the discriminatory actions taken against them, any harm suffered as a result, and whether these actions were believed to be because of any protected attributes. Additionally, the form inquires about the involvement of the employer, union, or employment agency in the discrimination, the employment details of the aggrieved party, consent for identity disclosure, and past efforts to seek assistance or file charges with the EEOC or other entities. Designed to help the Commission assess jurisdiction and the relevance of complaints, the intake process is voluntary yet pivotal for the accurate and efficient processing of discrimination charges. Information provided can be used by the EEOC to determine the legitimacy of claims and may be shared with relevant state, local, and federal agencies as necessary, highlighting the form's significance in the fight against workplace discrimination.

QuestionAnswer
Form NameEeoc Form 283
Form Length3 pages
Fillable?Yes
Fillable fields75
Avg. time to fill out45 sec
Other namesform 50 283, osdh fillable form 283, form 283, fillable form 283

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