Fillable DISCREMINATION AND/OR HARASSMENT COMPLAINT FORM (City of Stephenville)

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DISCREMINATION AND/OR HARASSMENT COMPLAINT FORM (City of Stephenville)

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DISCREMINATION AND/OR
HARASSMENT COMPLAINT FORM
NAME: DATE:
TITLE:
DEPARTMENT: SUPERVISOR:
Reason(s) for Unlawful Treatment:
__Religion __Sex __Disability
__Race __National Origin
__Color __Retaliation
__Age
__Other (Please List):
The City of Stephenville will not tolerate employment discrimination or harassment based upon an employee’s or
applicant’s race, color, national origin, sex, religion, disability, or age, according to Policy 7.06 Harassment &
Discrimination.
Employee Signature Date
Appendix E
Form 20
Briefly Describe the Nature of the Complaint. Please explain why you believe discrimination and/or harassment has
affected your employment with the City of Stephenville. Where possible, specify the date(s) of the incident(s) and
name(s) involved. If additional space is needed, please attach additional pages.
Page 227 of 254
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DISCREMINATION ANDOR HARASSMENT COMPLAINT FORM (City of Stephenville)

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Completed 16 July 2020

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