EEO Complaint Procedure and Form - ripta

Do you think the discrimination against you involved: (check one)[ ] Hiring[ ] Layoff/Furlough[ ] Transition[ ] Recall (from layoff-furlough)[ ] Wages[ ] Seniority[ ] Job Classification[ ] Intimidation/Reprisal[ ] Discharge/Termination [ ] Harassment[ ] Promotion[ ] Access/Accommodation[ ] Training[ ] Union Activity[ ] Transfer[ ] Union Representation[ ] Qualification/Testing [ ] Application[ ] Grievance Procedure [ ] Enrollment[ ] Referral[ ] Exclusion[ ] Placement[ ] Benefits[ ] Performance Appraisal[ ] Discipline/Reprimand[ ] Other: Specify________________________________________________Why do you believe these events occurred? _______________________________________________________________________________________________________________________________________________________________________________________________________________________What other information do you think is relevant to our investigation? ________________________________________________________________________________________________________________________________________________________________________________________________If this complaint is resolved to your satisfaction, what remedies do you seek?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Please list any persons that we may contact for additional information to support or clarify yourcomplaint (witnesses, fellow employees, supervisors, or others)Name: ________________________________________Phone number: __________________________Name: ________________________________________Phone number: __________________________Name: ________________________________________Phone number: __________________________Name: ________________________________________Phone number: __________________________Please send complaint form to:Mark TherrienRIPTAEEO Program705 Elmwood AveProvidence, RI 02907