Discrimination/sexual Harassment Complaint Form printable pdf download

Discrimination/sexual Harassment Complaint Form

BALTIMORE COUNTY PUBLIC SCHOOLS

EMPLOYEE DISCRIMINATION /HARASSMENT

COMPLAINT FORM

Under Title VII of the Civil Rights Act, the American with Disabilities Act (ADA) and the Age

Discrimination in Employment Act (ADEA), it is illegal to discriminate in any aspect of employment

including hiring, firing, compensation, assignment, classification, transfer, promotion, layoff, recall,

job advertisements, recruitment, testing, use of company facilities, training, fringe benefits, pay,

retirement plans, disability leave or other terms and conditions of employment.

Harassment is a form of employment discrimination and is unwelcome conduct that is based on race,

color, gender, religion, national origin, age, sexual orientation, marital status, genetic information,

disability, veterans status, or any other protected basis under federal, state, or local laws

The Baltimore County Public Schools EEO Office investigates complaints of discrimination and

harassment based on race, color, gender, religion, national origin, age, sexual orientation, marital

status, genetic information, disability, veterans status, or any other protected basis under federal,

state, or local laws.

Complaints of Discrimination and Harassment

INSTRUCTIONS: Please provide all of the information requested. Be as specific as possible when

discussing incidents of harassment / discrimination. Include the date(s) the incident(s) occurred, the

name(s) of the person(s) involved and the name(s) of those who may have witnessed the incident.

Your complaint is not limited to the space provided. You are encouraged to attach additional

materials, which may assist in the investigation process.

EMPLOYEE INFORMATION

Name:

Address

Telephone: (

)

Email:

Job Title:

Work Location:

Supervisor:

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Discrimination/sexual Harassment Complaint Form