Your Contact Information

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Address(Required)

Section Break

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Address(Required)

Type of Discrimination

Please select below(Required)
Was there a criminal record question on your employment or housing application?(Required)
Were you asked about one or more of the following (regarding either a misdemeanor or felony)?(Required)
For employment complaints: Were you asked about your criminal history at any stage of the application process? Check all that apply.(Required)
Did you authorize the housing provider or employer to conduct a background check?(Required)
Were you given notice of an adverse decision based upon your criminal record?(Required)
Were you given a copy of your criminal record?(Required)
Were you given an opportunity to explain or correct any information in your criminal record?(Required)

Additional Information

Are you represented by an attorney or working with another agency/organization on this issue?(Required)

Instructions and Disclosure

I. Disclosure of Your Complaint.

Public Record. Under most circumstances, your complaint, and any documents submitted with your complaint, will be considered a public record and available to any member of the public upon request. In response to such a request, we generally will not disclose your name, address, phone number, or any other information that identifies you and will not disclose this form in response to any request that specifically seeks the complaint you submitted.

Disclosure to the Person or Entity that is the Subject of Your Complaint. In order to resolve your complaint, we may release information about this complaint to the person or entity that is the subject of your complaint.

Disclosure to Other Entities. Your complaint and any related information may be disclosed in its entirety to other law enforcement and regulatory agencies.

II. Consulting With a Private Attorney.

The AGO cannot give you legal advice and is not able to be your private attorney, but represents the public interest. If you have any questions concerning your individual legal rights or responsibilities you should contact a private attorney.

I acknowledge that I have read and understood the provisions above and certify that the information I have provided is true and correct to the best of my knowledge.​(Required)
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