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REAL PROPERTY TRANSACTION PRE-COMPLAINT QUESTIONNAIRE <br /> Page 4 of 4 <br /> Dates of Continuation of the discriminatory adverse actions <br /> Discrimination (Explain why the actions were because of your protected basis) <br /> Witnesses who have evidence of the discriminatory adverse actions <br /> Name Telephone(Home and Work) Address <br /> Closing Statement: I declare under penalty of perjury that the foregoing is true and correct. <br /> Signature <br /> Visit our Website at www.hawaii.gov/labor for ALL interactive and downloadable forms. <br /> (Rev. 10/05) <br />