Western Australian Consolidated Regulations

EQUAL OPPORTUNITY REGULATIONS 1986 - SCHEDULE 1

[Regulation 2]

FORM 1 EQUAL OPPORTUNITY COMMISSION (Agent for the Human Rights Commission) COMPLAINT/ENQUIRY FORM

Complete Parts A and B. After speaking with a Conciliation Officer, complete Part C and return the whole form to the Equal Opportunity Commission. PART A Name:............................................................................................................... Address:............................................................................................................ ...............................................................................Postcode............................ Telephone: (0 ) .................................... H (0 )..........................................W I am complaining about: Name of Person/Company/Organisation: ........................................................ .......................................................................................................................... Address: ........................................................................................................... Telephone: (0 ) ............................................H Date of alleged discrimination: ....................................................................... Ground of alleged discrimination (Please tick) — Race — Sex — Marital Status — Political Conviction — Religious Conviction — Other (Please specify) PART B Set out the details of the alleged discrimination. Enclose any documents, letters or notices that relate to your statement. Your statement may be written in any community language. .......................................................................................................................... .......................................................................................................................... ..........................................................................................................................

Page 2 .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... .......................................................................................................................... Signature: ............................................ Date: .......................................

Page 3 PART C Before completing this part, speak with a Conciliation Officer. Persons outside the metropolitan area may reverse charges on this call. It is important that you are aware of the different remedies for discrimination available under the laws which are now in force. You may be required to select the law under which you wish to proceed. You are advised to contact a Conciliation Officer and have this explained before you complete this part. Having discussed these matters with a Conciliation Officer, I wish to proceed under: (Please tick) Υ EQUAL OPPORTUNITY ACT (W.A.) Υ THE SEX DISCRIMINATION ACT (Federal) Υ THE RACIAL DISCRIMINATION ACT (Federal) Υ THE HUMAN RIGHTS COMMISSION ACT (Federal) Signature: ............................................ Date: .......................................

Return this form to the EQUAL OPPORTUNITY COMMISSION 1ST FLOOR 5 MILL STREET PERTH WA 6000  3

[Forms 2-7 deleted in Gazette 30 Dec 2004 p. 7008.]

FORM 7

Equal Opportunity Tribunal

APPLICATION FOR FURTHER EXEMPTION OR VARIATION OF
EXEMPTION

Equal Opportunity Tribunal
No.    of 20

In the matter of an application

by

for further exemption/variation of exemption from the provisions of the Equal Opportunity Act 1984

...............................................................of..............................................................
hereby apply for further exemption/variation of exemption from the following provision of the Equal Opportunity Act — 

The exemption is sought for the period of..............................................................

..............................................

Applicant.

[Schedule 1 amended in Gazette 30 Dec 2004 p. 7008.]