Twin Rivers Unified School District COMPLAINT OF

Twin Rivers Unified School District
COMPLAINT OF DISCRIMINATION/HARASSMENT IN EMPLOYMENT
Complaint Form
Cov Board of Trustees txwv tsis pub cais lwm tus yam tsis raws cai los yog quab yuam koog tsev kawm
ntawv cov neeg ua hauj lwm vim nws yog lwm haiv neeg, xim nqaij, yug lwm teb chaws, nws tsev neeg,
nws kev ntseeg, nws lub hnub yug, puas muaj txwj nkawm, puas xeeb me nyuam, puas cev, muaj mob,
puas yog tub rog, puas yog poj niam los sis txiv neej, nyob hauv koog tsev kawm ntawv thiab/los sis hauv
cov koob tsheej. (Board Policy 4030.) Cov Board of Trustees txwv tsis pub quab yuam koog tsev kawm
ntawv cov neeg ua hauj lwm. (Board txoj cai 4119.11, 4219.11, 4319.11.)
Siv daim ntawv no yog koog tsev kawm ntawv cov neeg ua hauj lwm los sis tus neeg ua hauj lwm muaj
lus tsis txaus siab hais txog kev cai los yog kev cais uas lwm tus ua tsis raws txoj cai qhia hauv koog tsev
kawm ntawv tias tsis pub cais thiab tsis pub lwm tus quab yuam nyob rau hauv chav ua hauj lwm.
(Administrative Regulations 4031, 4119.11, 4219.11, 4319.11.)
Daim ntawv sib foob no tsuas siv raws li 3 nqi lus no xwb. Thaum ua tiav lawm, daim ntawv no yuav
tau muab rau tus Associate Superintendent, Human Resources/Labor Relations, 5115 Dudley Blvd.,
Bay B, McClellan, CA, 95652, (916) 566-1600.
I. Kev Sib Hu:
Npe ntawm tus neeg ua daim ntawv no:
Chaw Nyob:
Zos::
Zip:
Xov Tooj:
Email:
Koj ua daim ntawv no rau koj tus kheej los sis rau leej twg?  rau koj tus kheej  rau lwm tus
Yog koj ua rau lwm tus, thov qhia lub npe ntawm tus neeg no:
Lus Zais Npog: Tag nrho cov lus tsis txaus siab los sis kev liam hais txog kev cais los sis kev quab
yuam yuav tau zais npog raws li txoj cai tsuas yog saib tau thaum muaj kev tshawb xyuas, txiav txim
thiab kev tsom kwm.
II. Nws Txoj Hauj Lwm (Classification/Assignment/Position)
Npe (Title) los sis nws txoj hauj lwm :
Nyob Qhov Twg (Lub tsev kawm los sis chav):
Tus thawj (Supervisor) Npe:
III. Lus Tsis Txaus Siab: Cais, Quab Yuam, Pauj Kua Zaub Ntsuab
Thov khij hauv qab no thiab qhia seb lawv tau ua li cas rau koj, cias, quab yuam, los sis pauj kua zaub rov
qab:
 Yog Poj Niam/ Yog Txiv Neej
 Poj Niam/Txiv Neej*
 Haiv Neeg
 Caj Ces
 Teb Chaws Yug
 Kev Ntseeg
 Xim Nqaij
 Tsev Neeg
 Puas Cev
 Hnub Nyoog
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 Muaj Feem Txog Tej Pawg No
 Quab Yuam Thab
 Deev (Title IX)
 Pauj kua zaub
*Raws li txoj cai hauv lub xeev, “’Gender’ yog ntiag tug ntawm ib tug neeg nws tus kheej thiab muaj
feem txog nws tus cwj pwm los yog kev ua saib tsis taus nws thaum nws yug los.” Education Code koog
201.7.
IV. THOV QHIA TXOG QHOV HAJ TOM UAS KOJ TSIS TXAUS SIAB
Thov qhia txog qhov teeb meem uas koj tsis txaus siab, qhia kom meej.
Siv sab nrauv los sis lwm daim ntawv ntxiv.
Thov qhia qhov teeb meem uas raug rau koj es koj tsis txaus siab, lawv ua li cas rau koj, qhia kom meej
meej:
Sau cov npe ntawm txhua leej uas muaj feem es koj tsis txaus siab txog:
Sau seb puas muaj cov pom thaum muaj qhov teeb meem no:
Qhia seb cov teeb meem no tshwm sim nyob rau qhov twg:
Thov sau tag nrho seb yog hnub twg thiab cov sij hawm thaum muaj qhov teeb meem no tshwm sim los
sis thaum nyuam qhuav pib es koj paub:
Tsawg theem, yog muaj, uas koj twb ua los daws qhov teeb meem no ua ntej koj hais tias koj tsis txaus
siab?
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Qhia seb puas muaj tej yam raug rau koj vim qhov teeb meem saum no tau tshwm sim.
Qhia seb xav thov kom muab kho li cas:
V. Tshaj Tawm Cov Lus Tsis Txaus Siab
Kuv tshaj tawm hais tias yog kuv dag kuv yuav raug txim raws li kev cai hauv Xeev California kuv cov
lus no yeej muaj tseeb tiag.
Tus neeg ua daim ntawv no suam npe:
Hnub:
Sau Npe:
Sau lub zos thiab lub xeev seb kos nyob qhov twg:
RAU KOOG TSEV KAWM NTAWV SIV XWB
Txais los ntawm:
Hnub Txais Tau:
Npe (Title) ntawm tus neeg tau txais cov lus tsis txaus siab no:
Thov muab luam ib daim rau tus neeg uas nws tsis txaus siab.
00596-00188/502015.1
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