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Distribution of Form: (Equal Employment Coordinator)
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| Building: | |
| Date of Filing: | |
| Date Violation Occurred: | |
| Date Level I Meeting Held (Optional): | |
| Parties Present at Level I Meeting: | |
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Nature of Complaint:
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Remedy Requested:
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| Signature: | |
| Date Signed: | |
| Address: | |
| Phone: | |
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Disposition of Chief Officer of Human Resources/Equal Employment Coordinator:
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| Signature: | |
| Date Signed: | |
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Chief Officer of Human Resources/Equal Employment Coordinator's Disposition
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| Signature of Complainant: | |
| Date Signed: | |
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Disposition of Superintendent:
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| Signature: | |
| Date Signed: | |
Reviewed: 9/14; 12/16; 4/20; 4/23
Revised: 8/25
Related Policy: 400.1