Navigating the complexities of reporting discrimination can be challenging, but the MCAD Intake Interview Form serves as a crucial first step in this journey. This document is not a formal complaint form; rather, it is designed to collect preliminary information from individuals who believe they have been subjected to discriminatory practices. The form requests detailed personal data, including name, contact information, and demographic details, which are vital for the Massachusetts Commission Against Discrimination (MCAD) to understand the context of the potential complaint. It also probes into the employment situation of the complainant, asking for information about the employer, such as the business name, address, and the nature of its operations. Importantly, the form covers the types of discrimination the complainant believes they have experienced—ranging from issues related to employment, public accommodations, and education, to more specific areas such as sexual harassment, disability, and racial discrimination. The document seeks to gather a comprehensive overview of the circumstances, including the alleged discriminatory acts, the individuals involved, and any differential treatment the complainant believes to have faced in comparison to others. Although it marks only the beginning of what can be a rigorous process, by collecting such essential information, the MCAD Intake Interview Form plays a pivotal role in facilitating individuals' pathways towards seeking justice.
| Question | Answer |
|---|---|
| Form Name | Mcad Complaint Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | mcad comnplaint form, mcad complaint sample, complaint form mcad, mcad omplaint process |
(This is not a Complaint Form and will not be processed as a certified Complaint)
MCAD
INTAKE INTERVIEW FORM
Please provide the Commission with the following information:
First name: __________________________ Middle initial: _____ Last name: ____________________
Address: ____________________________________ City: ______________ State: ______ Zip: ___________
Phone No: _____________________ Email Address: ______________________________________________
Sex: ____________ Marital Status (optional): _______________________ Race: __________________
Emergency Contact Information: Name: ___________________________ Phone No.: ___________________
How did you hear about us?
Do you have other complaints filed with us against the same Respondent? ( ) No ( ) Yes
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Employer Information:
Name of Employer: _________________________________ Address: _________________________________
City: ___________________ State: ___________ Zip: ____________ Phone No.: _____________________
Primary business of company: _______________________ Occupation/Job title: __________________________
No. of employees: ________ Name of person(s) who discriminated against you: __________________________
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Please check off appropriate box: |
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( ) Employment |
( ) Public Accommodations |
( ) Education |
( ) Credit |
( ) Other |
Type of Discrimination: (please check off appropriate box(es)):
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) Race ( ) Color |
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) National Origin ( |
) Age |
DOB: |
( ) Sex/Gender |
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) Sexual Harassment |
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) Sexual Orientation |
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) Disability/Reasonable Accommodation ( ) Retaliation |
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() Religion/Religious Accommodation ( ) Criminal Record ( ) Maternity Leave ( ) Genetics
Please indicate the date of the last act of discrimination:
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Please summarize the employment decision that was taken against you by your employer: _____________________
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Summarize why you feel these actions were discriminatory: ____________________________________________
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List all the people who were given more favorable treatment than you: ____________________________________
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Signed by: ___________________________________________________ Date: ___________________
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MCAD OFFICIAL USE ONLY (PLEASE NOTE: This is not a complaint form).
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) Consult |
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) Complaint Filed |
Intake Interview Form |
April 2010 |