Fillable Oak059451 EA Complaint Form SP.pages (City of Oakland)

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Oak059451 EA Complaint Form SP.pages (City of Oakland)

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The Oak059451 EA Complaint Form SP.pages (City of Oakland) form is 1 page long and contains:

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File type: PDF

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INFORMACION DE CONTACTO
Nombre: __________________________________________________________________________________________
Direccion:_________________________________________________________________________________________
No. de Teléfono:____________________________ Correo Electrónico:________________________________________
DETALLES DE LA QUEJA
Fecha del incidente:__________________________________________________________________________________
Departamento/Agencia:_______________________________________________________________________________
Ubicación o dirección: _______________________________________________________________________________
Problema de Acceso a Idiomas: (Marque todas las que apliquen)
Falta de señales informando al público sobre servicios de traducción
Falta de información escrita en español/chino Falta de personal bilingüe Otro
¿En qué idioma necesito ayuda?________________________________________________________________________
Descripción breve: (agregue paginas adicionales si es necesario) ______________________________________________
__________________________________________________________________________________________________
ASISTENCIA CON EL FORMULARIO
¿Alguien le ayudo a completar este formulario? Si " No
Nombre:___________________________________________________________________________________________
Organización: ______________________________________________________________________________________
Teléfono:_______________________________ Correo electrónico:___________________________________________
DEPARTMENT USE ONLY
Por favor envíe este formulario a: EQUAL ACCESS OFFICE Department of Human Resources Management,
150 Frank H. Ogawa Plaza 2nd Floor, Oakland, CA 94612
Tambien puede enviarlo por fax al (510) 238-2325. Si tiene alguna pregunta llame al (510) 238-3112.
FORMULARIO DE QUEJAS SOBRE ACCESO A IDIOMAS
El propósito de este formulario es registrar quejas relacionadas con el acceso a idiomas en las
oficinas de la Ciudad.
Date Received:
Action Taken:
Contact Person:
Phone:
Email:
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Oak059451 EA Complaint Form SP.pages (City of Oakland)

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Completed 20 July 2020

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