Sexual Harassment Form

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SEXUAL HARASSMENT CONSENT FORM

Name: __________________ Social Security Number:_______________
Address: __________________________ City:____________________
Department: __________________ Home Phone Number:___________
Office Phone Number: ___________

Male □ Female □

Sexual Orientation:
Male / Female □
Male / Male □
Female / Female □
All Of The Above □
None Of The Above - Please Elaborate: _____________

I CONSENT TO THE FOLLOWING FORMS OF SEXUAL HARASSMENT:

Salutatory Greetings: □

Eye-To-Eye Contact:□ Eye-To-Bust Contact:□ Eye-To-Crotch Contact:□

Heavy Breathing On: Neck:□ Ear:□ Other:□

Hands On: Body:□ Shoulder:□ Waist:□ Gluteus Maximus:□ Other:□

Feelies:□ Gropies:□ Penetration(However Slight):□ Other:□ All Of The Above:□


MISCELLANEOUS: I WILL: □ I WILL NOT: □

1. Assist in the procurement of various potions, lotions, products, appliances, etc. to be used during sexual harassment.

2. Assist in procurement and maintenance of various types of electronic or mechanical sustaining apparatus.

3. Clean up.


I CERTIFY THAT I WILL ACCEPT SEXUAL HARASSMENT FROM:

Anyone: □
Anyone But: ___________________________________
Only: _________________________________________


Signature; ____________________ Date: __________________

This form is to be reviewed by your immediate supervisor annually, prior to performance rating and evaluation.