SEXUAL HARASSMENT FORM

Si cree que ha sido objeto de acoso sexual o discriminación de género, se le recomienda, pero no se le exige, que complete este formulario. Cuando haga clic en “Enviar”, su formulario será enviado a nosotros y revisado por nuestro departamento de recursos humanos. Ningún empleado será objeto de represalias por presentar una queja.

Si se siente más cómodo informando verbalmente o de otra manera, comuníquese con Lance Herman (lance@starhg.com) o Wilmary Rodriguez (wrodriguez@starhg.com) o llámenos al 212.661.6148.

Complainant Information

First Name *

Last Name *

Email *

Phone *

Select Preferred Communication Method

Select Preferred Communication Method

• Email
• Phone
• In Person

Supervisory Information

Supervisor's First Name

Supervisor's Last Name

Complaint Information

Your complaint of sexual harassment is made about

First Name

Last Name

Work Location

Relationship To You

Supervisor

Supervisee

Co - Worker

Other (Please Specify)

Please describe what happened and include as many details as possible

Date(s) Sexual Harassment Occurred (start)

Date(s) Sexual Harassment Occurred (end date)

Is the sexual harassment continuing?

Is the sexual harassment continuing?

• Yes
• No

If possible, please list the name and contact information of any witnesses or individuals who may have information related to your complaint:

Have you previously provided information (verbal or written) about related incidents? If yes, when and to whom did you provide information?

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