Acts of discrimination, harassment, and retaliation in the workplace are inappropriate and will not be tolerated. Acts of discrimination, harassment and retaliation may be cause for disciplinary action, up to and including termination.
(Ord. 2008-85. Passed 11-19-08.)
Exhibit A The Village of Woodmere 27899 Chagrin Boulevard, Woodmere Village, Ohio 44122 EEO DISCRIMINATION COMPLAINT FORM 1. Name: 2.( ) (Last) (First) (MI) (Office Phone #) 3. Address 4.( ) (Number and Street) (City) (Zip) (Home Phone #) 5. Are you presently working for the Village of Woodmere? Yes No 6. Check the appropriate area(s) of discrimination: Race National Origin Age (40+ years) Military Status Color Sexual Orientation Religion Disability 7. Check to appropriate area(s) of discriminatory harassment: Race National Origin Age (40+ years) Military Status Color Sexual Orientation Religion Disability 8. Retaliation (based on involvement with a discrimination complaint) 9. Race of the complainant: Black White Hispanic/Latino Native American Asian/Pacific Islander 10. Sex of the complainant: Male Female 11. Name the Department you believe has discriminated against you: 12. Name(s) and title(s) of person(s) who you believe discriminated against you: (Name) (Title) 13. Have you filed a complaint with the Federal EEO Commission? Yes No 14. Have you filed a complaint with the Ohio Civil Rights Commission? Yes No 15. Have you filed a Union grievance regarding the incident(s)? Yes No 16. Date of alleged discrimination: (Month) (Date) (Year) 17. Explain how you believe you were discriminated against (treated differently from other employees or applicants) because of your race, color, religion, sex, national origin, disability, age (40+ years), sexual orientation, gender identity, or military status. (Complainant’s Signature) (Date) |
15. Have you filed a Union grievance regarding the incident(s)? Yes No 16. Date of alleged discrimination: (Month) (Date) (Year) 17. Explain how you believe you were discriminated against (treated differently from other employees or applicants) because of your race, color, religion, sex, national origin, disability, age (40+ years), sexual orientation, gender identity, or military status. (Complainant’s Signature) (Date) |