57 lines
2.7 KiB
Plaintext
57 lines
2.7 KiB
Plaintext
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SEXUAL HARASSMENT CONSENT FORM
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NAME: ........................ SOCIAL SECURITY NO.:...................
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ADDRESS: ..................... CITY: .................................
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STAFF ELEMENT: ............... HOME TELEPHONE NO.: ...................
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MALE: ..... FEMALE: .......... OFFICE TELEPHONE NO.: .................
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SEXUAL PREFERENCE:
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Male - Female:............... Male - Male: ..........................
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Female - Female: ............ All of the Above: .....................
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None of the Above: .................
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I consent to the following forms of sexual harassment:
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Salutatory Greetings: ...............................
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Eye - to - Eye Contact: .............................
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Eye - to - Bust Contact: ............................
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Eye - to - Below - Waist Contact: ...................
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Heavy Breathing on Neck: ............................
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Ear: .............................
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Other: ...........................
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Hands on Body: ......................................
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Shoulder: ..................................
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Waist: .....................................
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Gluteus Maximus: ...........................
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Other: .....................................
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Feelies: ............................................
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Gropies: ............................................
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Penetration, However Slight: ........................
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Other: ..............................................
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All of the Above: ...................................
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MISCELLANEOUS: I WILL .......... I WILL NOT ..........
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1. Assist in procurement of various potions, lotions, products,
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etc., to be used during sexual harassment.
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2. Procurement and maintenance of various types of sustaining
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apparatus.
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3. Clean up.
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I certify that i will accept sexual harassment from:
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Anyone: ...........
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Anyone But: ............................................................ ...........................................................
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Only: .................................................................. .................................................................
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SIGNATURE: ........................................ DATE: ....................
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This form is to be reviewed by immediate supervisor annually, prior to
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performance rating and evaluation.
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