Fillable Effective on and after September 1, 2019, the (Colorado DORA)

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Effective on and after September 1, 2019, the (Colorado DORA)

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The Effective on and after September 1, 2019, the (Colorado DORA) form is 3 pages long and contains:

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  • 3 check-boxes
  • 32 other fields

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Colorado Department of Regulatory Agencies (DORA) is responsible for professional licensing and consumer protection in Colorado USA.

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Division of Labor Standards and Statistics
633 17th Street, Suite 600
Denver, CO 80202-2107 | (303) 318-8441 | colorado.gov/cdle/labor
Colorado Division of Labor Standards and Statistics | 633 17
th
Street, Suite 600 | Denver, CO 80202-2107
Main: (303) 318-8441 | Toll Free: 1-888-390-7936 | Fax: (303) 318-8400 | Email: cdle_labor_standards@state.co.us
October 2019
Colorado Chance to Compete Act Complaint Form
Effective on and after September 1, 2019, the Colorado Chance to Compete Act, C.R.S. § 8-2-
130, prohibits employers with 11 or more employees from 1) stating in an advertisement for an
employment position that a person with a criminal history may not apply for the position; 2)
stating on any form of application, including electronic applications, for an employment
position that a person with a criminal history may not apply for the position; or 3) inquiring
into, or requiring disclosure of, an applicant’s criminal history on an initial written or electronic
application form. For more information, visit colorado.gov/cdle/labor.
Section I: Complainant Contact Information (To file anonymously, skip to Section II)
First Name
Middle Initial
Last Name
Mailing Address
City
State
Zip Code
Primary Phone
Alternate Phone
Email Address
Preferred Contact Method
Mail ☐ Phone ☐ Email ☐
Section II: Employer Contact Information – Complete this section to the best of your knowledge. Missing
information or incomplete forms may delay the complaint process.
Employer Name
Employer Contact Person Name
Employer Mailing Address
City
State
Zip Code
Employer Email Address
How many employees does the employer have?
11 or more employees ☐ Fewer than 11 employees ☐ Unknown ☐
Division of Labor Standards and Statistics
633 17th Street, Suite 600
Denver, CO 80202-2107 | (303) 318-8441 | colorado.gov/cdle/labor
Colorado Division of Labor Standards and Statistics | 633 17
th
Street, Suite 600 | Denver, CO 80202-2107
Main: (303) 318-8441 | Toll Free: 1-888-390-7936 | Fax: (303) 318-8400 | Email: cdle_labor_standards@state.co.us
October 2019
Section III: Description of the Alleged C.R.S § 8-2-130 Violation (Please check and complete the boxes
that apply and provide an explanation of what happened)
1. Did the employer state in an advertisement for an employment position that a person with a
criminal history may not apply for the position? Yes ☐ No☐
If yes, please explain:
2. Did the employer state on any form of application, including electronic applications, for an
employment position that a person with a criminal history may not apply for the position?
Yes ☐ No☐
If yes, please explain:
3. Did the employer inquire into, or require disclosure of, an applicant’s criminal history on an
initial written or electronic application form? Yes ☐ No☐
If yes, please explain:
Division of Labor Standards and Statistics
633 17th Street, Suite 600
Denver, CO 80202-2107 | (303) 318-8441 | colorado.gov/cdle/labor
Colorado Division of Labor Standards and Statistics | 633 17
th
Street, Suite 600 | Denver, CO 80202-2107
Main: (303) 318-8441 | Toll Free: 1-888-390-7936 | Fax: (303) 318-8400 | Email: cdle_labor_standards@state.co.us
October 2019
Section IV: Supporting Documentation (Please attach to the complaint form)
You should provide the Division with relevant documentation to support your claim by attaching it to
this complaint form. Supporting documentation may include a copy, photo, or screenshot of the job
advertisement, or a blank job application.
If you do not have supporting documentation, describe in detail any additional information for your
allegation that this employer has violated the Colorado Chance to Compete Act C.R.S. § 8-2-130, below:
To the best of my knowledge, I affirm that the information I have provided is true and correct:
Name (or “Anonymous”) Signature (If Anonymous, leave blank) Date
Please mail, fax, email, or deliver this complaint form and any attached documentation to:
Mailing Address:
Colorado Division of Labor Standards and Statistics
633 17
th
Street, Suite 600
Denver, CO 80202-2107
Fax: (303) 318-8400
Email: cdle_labor_standards@state.co.us
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Completed 20 July 2020

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