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Georgia Department of Juvenile Justice
Office of Human Resources
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Katrina Patterson, Director
DJJ Web Site
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Request

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Current Position or Title
Job Title:
On Behalf Of
Person to Contact:
Tel / Contact #:
Location Category:
Title:
Email:
   
Location:
Complainant Information
Prefix:
Name (Last, First):
,
Tel/Contact#:
Email:
Location Information
Final Office Name:
Primary Phone #:
Address:
City, State Zip
City
Location Contact Info
Location director
Other
(override email address)
Location Asst directorNone specified
Other
(override email address)

LocationApproverNames:

LocationApproverEmails:

Org -Division/Office   (Important: Controls Division approvers for this request)
Division:
Office:
DivisionApproverNames :

DivisionApproverEmails:
ACName:
ACEmail:

Region
Primary Region
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to show Regions. Select III for Central
District
Primary District:
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to show Districts. Select 3B for Central
Requirements
Requirement Details:

Request Summary
Summary of important elements of the request:
Approvers
Approving Name:
Name of Supervisor, Director, or Division Head
Approver Email Address
Approver Telephone
Detailed Notes
Provide Detailed notes or any other information below:
Narrative
Provide a narrative below:
Inbound Email Information
Email Below is from inbound email:
From:
To:
Subject:
Body of incoming email

Request Origin
Origin of Complaint:
Request Type Selection







ER Complaint
Clear and Reload New
Clear and Reload Current (Direct)
Err
Quick Note To Requester
Email Control
Requester(s)?
Additional To:
Additional CC:


Other CC:
Instructions for Sexual Harassment Complaint




Request For Interview
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Instructions...

Refer to DJJ Policy 3.23 regarding filling a complaint and for a list of grievable issues.


As Per Governor Kemp's Executive Order 01.14.19.02, each executive branch agency shall promptly review all complaints of sexual harassment and/or retaliation and immediately report any complaint made directly to the Office of the State Inspector General utilizing the form below.


Complainant Information (individual who allegedly experienced sexual harassment or retaliation)

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First Name + Your Browser does not support SVG
Last Name + Your Browser does not support SVG
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Job Title + Your Browser does not support SVG
Facility + Your Browser does not support SVG
Facility Work Address
    Respondent Information (individual whom the complaint is about)
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    First Name + Your Browser does not support SVG
    LastName + Your Browser does not support SVG
    Phone Number
    Job Title
    Relationship to Complainant + Your Browser does not support SVG
    If you need to select multiple options, please select "OTHER" and describe in the box below
    Complaint Information
    Date of occurrence + Your Browser does not support SVG
    Have you discussed this issue with your supervisor? + Your Browser does not support SVG

    List specific problem(s)/issue(s) + Your Browser does not support SVG
    (Descibe what happened, when and where, how your employment has been unfavorably affected, and indicate names of others involved. Attach any supporting documentation)
    Has any conduct been reported to a law enforcement agency? + Your Browser does not support SVG
    Are there concerns that the agency cannot fairly or impartially investigate the complaint? + Your Browser does not support SVG







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