Real Property Transaction - Questionnaire Form

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REAL PROPERTY TRANSACTION PRE-COMPLAINT QUESTIONNAIRE Page 3 of 4 Directions: Please provide a summary of the discriminatory adverse actions with the names of those who discriminated against you. Start with the earliest date and end with the last date. Use separate sheets of paper as necessary. On the next page, include the name/telephone/address of witnesses who have evidence of the discrimination. Dates of Describe the discriminatory adverse actions Discrimination (Explain why the actions were because of your protected basis) Visit our Website at www.hawaii.gov/labor for ALL interactive and downloadable forms. (Rev. 10/05)