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  • Chan Complaint

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    Rickey Stokes
    12K vues4 pages
    Complaint with EEOC on Honeysuckle Middle School

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    Complaint with EEOC on Honeysuckle Middle School

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    12K vues4 pages

    Chan Complaint

    Transféré par

    Rickey Stokes
    Complaint with EEOC on Honeysuckle Middle School

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    sur 4
    _ ON ay U.S. EQUAL EMPLOYMENT OPPORTUNITY COMMISSION INTAKE QUESTIONNAIRE a Rew lease immediately complete this entire form and return it to the U.S, Equal Employment Opportunity Commission (“EEOC”). REMEMBER, a charge of employment discrimination must be filed within the time limits imposed by law, within 180 days or in some places within 300 days ofthe alleged discrimination. When we receive this form, we will review ito determine EEOC coverage. Answer all questions completely, and attach additional pages if needed to complete your responses. If you do not know the answer to a question, answer by stating “not known.” If a ‘question is not applicable, write “N/A.* (PLEASE PRINT) 1. Personal Information Las Name:___C. Fir Name; L-QULYOL, py th = 3 ms “AI A County: OASHOVY sure: AL _zip:_BLFIOS ‘Suet ot Mailing Address Sex: Male (Female Do You Have a Disability? C1 Yes\WZ°No Please answer each of the next three questions. i. Are you Hispanic or Latino? O Yes SYNo ii What is your Race? Please choose all hat apply. C] American Indian or Alaskan Native Cl Asian Of white Black or African American Native Hawaiian or Other Pacific Islander Ii, What is your National Origin ounty of origin or ancesuyy? AMNey CON, Plesee Provide The Name OF A Person We Can Contact If We Are Unable To Reach You: Name: SiGe HiclS Retaiontip:_ Apto OEY adaress: PHBOY VK cig: Digbeyile—stae: PHL zip cose: 3Q310 Home Phone: (__)__ NU Other Prove: 8 7190 - HOOF _ 2 Vhelive that Ywas discriminated against by te following organinstions): (Check hose that spp) ff Employer C1 Union (1 Employment Ageney Other ene Spec) Ss Organization Contact Information (If the organization is an employer, provide the address where you actully worked. If you ‘work from home, check here C1 and provide the address of the office to which you reported.) If more than one employer is Gromiaton Names Stn Cu Schools Address: BOS Dusg Secs ! was — Rous ag —— cox DOMAN. cue ap SORDI Paw 0635 “143-15 Type of Business: ADR | Job Location if different from Org. Adares: Hoveysuctle Middle Schost. Human Resources Direc or Owner Name: TOAG Udoees Phone: 24) 793— 347 ‘Number of Employees in the Organization at All Locations: Please Check (/) One Ol Fewer Than i5 15-100 © 101-200 201-500 More than 500 3. Your Employment Data (Complete as many items as you are able.) Are you a federal employee? 11 Yes C1 No pare HireeFOLL QOL) sop tie arstie: SCAOOD| NUS. Pay Rate When Hirea: ont VRCOUC rast or Current Pay Rate: QO Job Title at Time of Alleged Discrimination: SONAL NWS, _ ate QuivDischarged: NYE Name and Tie of immediate Supervisor: ey —TErrente, If Job Applicant, Date You Applied for Job NY [AE Job Tite Applied For_ 0) (4 ie 9 Age Din 0 Natu Og eugion Renn O Peony Bex meas ‘hin Sheds win he soe rove) El Genvartformaton, cle wich peso Beets maton ‘my medial sory” i gene svices (pees Serves rans couing earn sng) peo 1 you checked calor eiion of masons origin, pleme spit {IW you checked senate information, how di the employer obulo he gens nfrmaton? WY ter reson (a) for dieriminion Expaiy a Nat hppane a that you ewe ws Garni? Ino Be a) of a. On ‘peta the person) who sou blew darn agate vou. Pace atach Stier ES Doe ‘Geample: 1105106 = Discharged by itt ohn Sots Toss Se AL Date: Action: See OHadud Sass for oll “EWS rover De [Name and Title of Person(e) Responsible: B. Date: ‘Action: [Name and Titl of Person(s) Responsible 6. Why do you believe these actions were discriminatory? Please attach additonal pages if needed. 7. What reason(s) were given to you for the acts you consider discriminators? By whom? His or Her Sob Tile? Ke . 8. Describe who was in the same or similar situation as you and how they were treated. For example, who se applica for the same job you did, who else had the same attendance record, or who else had the same performance? Provide the race, sex, age, national origin, religion, or disability of these individuals, if known, and if i relates to your daim of discrimination. For example, if your complaint alleges race discrimination, provide the race of each person; i it alleges provide the sex of each person; and so on. Use additional shests if needed. ‘sex discrimination, (Of the persons in the same or similar situation as you, who was treated better than you? i Description of Treatment Race, Sex. Age, National Orig, Reliion or Dasty Jo Tie nue, el rch er oor a Ogee Scposi nue. n sam Gallawxiy ent act fenea) eral, oeonMt dune sniucs ligliler work [dod Same pay scale 2 THESE PUES alse Ga 4 neve 0 sadn Chases like nurse Horne RN ON our work 50 ney hav, mow frre Complue Inert pape, ee a “ore persons in the same of snilar situation as you, who was treated were than you? ee "Hace Sex, Age, National visio Relist or Duabily Job Tie a Wp WE (Of the persons inthe same or sillr situation a¢ you, who was treated the sume a you? ‘Full Name Hace, Sex, ‘ob Answer questions 9-12 only if you are claiming discrimination haed on disability. Ifnot, skip to question 13. Place tell tus if you have more than one dlsabiley. Please add additional pages if needed. he Please check all that apy: 1D Yes, Hhwve a dsb, ‘ag Me 1D do not ave a disability now but 1 did have one 1D No disability bur the organization treats meas if am disabled the disability chat you belive is the reason forthe adverse action taken aguint you? Docs this disability 20. you from dolog anything? (e-., ling, seeping, breathing, walking, caring for yourself, working, et). prevent 11, Do you wee: medical equipment or anything ele to lessen or eliminate the symptoms of your disability? Yes No IF Yes,” what medication, equipment or other assistance do you use? 12, Did yoo as your employer fotny changes or sistance to do your job becanse of your sity? 1f “Yes,” when did you ask? low di you ask (verbally or in writing)? Who did you ast? (Provide fullname and jolie of person) la eae How did your employer respond to your request? ‘Aes & Phone Number Wat do you believe this person willl as? am ae F there any witnesses to the alleged discriminatory incidents? I identify them below and tell us what yy Ee “7 3 ‘Ell Name Job Title 14, Have yu fled a charge previwly on hs miter wit the EOC waster agaey? Yes W/o 15. Ifyou filed 2 complaint with another agency, provide the mame of agency and the date offing: _N)|O 16. ‘Have yor sought help about this situation from 2 union, an attorney, or any other source? Wifes Ol No Prpuide pame of organization, nang of person you spe with an date of coset. Real, 3577 You would Ike ur do wi he fformation yoo ae providing o this ‘questionnaire. Ifyou woud lie 1 lea charge of jab dscriainaton, you mst 6 so ether win 180 days rom te ay yo ‘new abowt the discrimination, or within 300 day om he day you ew abou ihe discrimination if te employers Ioeated in 4a place where sae o local goverment agency enforces laws snr othe EEOC's laws. If you do nt fea charge of ‘isrimination within the tine limits, you wil lose sour rights. Ifyou would ke mare information before fling 2 charge ‘or you have concerns about EEOC's notifying the employer, ios, or employment agency about your charge, Sou ma} wish to check Box I. Ifyou want wo flea charge, you should check Box 2. BOX 1 O11 wart to ak wan EEOC employe before doing wiser w fle a care. Yuderand tat by checking tis box, have not fled a charge with the EEOC. Talo understand that 1 cold lee tay tgs iT donot ea charge in te. BOX 2 WT wan to file a charge of discrimination, and | euthorize the EEOC to look into the discrimination | described above. Tundersand dat the EEOC must give the employer, union, or emplayment agency that Iaccue of dicrinination information aboot the charge, including my name. Ils understand that be EEOC can only cept carps of ob

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