A Charge of Discrimination can be completed through our EEOC Public Portal after you submit an online inquiry and we interview you. Civil Rights Compliance - Discrimination Complaint Form.Disability discrimination occurs when a person who suffers from a disability is treated less favorably as an employee or a job applicant due to that disability. If you believe that you or someone else experienced unlawful discrimination, you can report a civil rights violation. 1. Report using our online form. Open and fill out the Civil Rights Discrimination Complaint Form Package in PDF format. Mail Fill out and send the paper ADA Complaint Form. You have various options to file a complaint after experiencing discrimination from a healthcare facility or individual healthcare provider. Record of psychiatric disability. The FCRA prohibits employers from discriminating against employees or job applicants due to physical or mental impairments, including learning disabilities.