|PRIVACY ACT STATEMENT|
(This form is covered by the Privacy Act of 1974; Public Law 93-579.
Authorities for requesting the personal data and the uses thereof are given below.)
- FORM NUMBER / TITLE / DATE. CCHRC Form 1, Intake Questionnaire, December 1999.
- AUTHORITY. City of Corpus Christi Ordinance No. 023411, as amended, Chapter 24, Article IV;
Title VII of the Civil Rights Act of 1964, as amended, 42 U.S.C. 2000e-4; and/or
the Americans with Disabilities Act of 1990, 42 U.S.C. 12101 et seq.
- PRINCIPAL PURPOSE. The purpose of this questionnaire is to solicit information to enable
the Commission to avoid the intake of matters not within its jurisdiction.
- ROUTINE USES.Information provided on this form will be used by Commission employees to determine the evidence of facts relevant to a
decision as to whether the Commission has jurisdiction over potential charges, complaints or allegations of employment discrimination.
Information provided on this form may be disclosed to other state, local, and federal agencies as may be appropriate or necessary in carrying out
the Commissioners' functions, including employment practice laws. Information may also be disclosed to charging parties in consideration of,
or in connection with litigation.
- WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND THE EFFECT ON INDIVIDUAL FOR NOT PROVIDING
INFORMATION. The providing of this information is voluntary but the failure to do so may hamper the Commission’s investigation of a
charge of discrimination. It is not mandatory that this form be used to provide the requested information.