Fair Chance Jobs Complaint Form

This form is for complaints regarding job applicants and employees whose criminal history impacted their application or employment status in violation of the Washington Fair Chance Act. See RCW 49.94 for employers' legal limitations in considering criminal history. For questions contact (833) 660 -4877 or email fairchancejobs@atg.wa.gov.

* Starred fields are mandatory in order to process your request.

1 Information About You

*Last Name:

*First Name:

Middle Name:

Pronouns:

Address:

*City:

*State:

*Zip:

*Contact Phone

Best day(s) of the week and time(s) of day to reach you by phone

*Contact e-mail address:

*Confirm e-mail address:

*Is this complaint about you? YesNo

What language should we contact you in?

2 Information About the Employer

*Employer Name:

Address:

City:

State:

Select State

Zip:

Name of Supervisor/Employer Contact:

*Last Name:

*First Name:

Employer Website:

Employer Phone Number:

*Number of employees who work for this business: 7 or less
8-14
15-49
50 or more

3 Information About this Complaint

Is this regarding:

*An employer taking an adverse action against an employee (regardless of time spent in their position) based on the employee's criminal history? (Examples of adverse action: rejecting an otherwise qualified job applicant; or terminating, suspending, disciplining, demoting, or denying a promotion to an employee.) YesNo

*An employer advertising an employment opening in a way that excludes people with criminal records from applying? (Examples: ads that state "no felons", "no criminal backgrounds", or otherwise convey similar messages.) YesNo

*An employer automatically excluding an applicant because of their criminal record? YesNo

*An employer asking for or obtaining an applicant's criminal record prior to making a conditional offer of employment? YesNo

*An employer making a hiring decision based on a criminal record before making a conditional offer of employment? YesNo

*An employer rejecting the applicant for failure to disclose a criminal record prior to making a conditional offer of employment? YesNo

*Failure to receive notification about the criminal record the employer relied on to make an adverse decision? YesNo

*An employer's failure to hold the job open for two days? YesNo

*No opportunity to explain or correct the record? YesNo

*An employer's failure to explain the basis for its adverse decision in writing? YesNo

*Retaliation for exercising rights under the Washington Fair Chance Act? YesNo

*An employer disclosing that the position is subject to a background check? YesNo

*An applicant voluntarily disclosing their criminal history without the employer asking? YesNo

*What job position is this complaint about?

*Please explain what happened:

4 Documents

Please provide any document relevant to this complaint. You may upload 5 files with a total file size limit of 20 megabytes, including a copy or photo of any job advertisement or blank job application form about which you are complaining.

Accepted Document Types: TXT, DOC, DOCX, XLS, XLSX, PDF
Accepted Image Types: JPG, TIF, TIFF, PNG, JPEG

Upload Attachments:

5 Privacy Notice, Disclaimer and Signature

Some or all of the information submitted on this form may constitute a public record. By selecting YES below, I acknowledge that my complaint and attachments, once submitted, may become a public record subject to review by the Attorney General's Office for applicable restrictions on disclosure. If you would rather submit your complaint via phone, you may do so by leaving a message at (833) 662-9934 and a staff member will return your call.

Yes

*Name: