Effective Dates (paydates)
Effective Dates (1st and 16th)
Deadline Dates
Georgia Department of Juvenile Justice
Office of Human Resources
A resource provided by The Administrative Applications Team of OTIS
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404-294-3431
Katrina Patterson, Director
DJJ Web Site
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Request

Request Contact Information
First Name: Last Name:
Phone Number: Email Address:
)
Current Position or Title
Job Title:
On Behalf Of
Person to Contact:
Tel / Contact #:
Location Category:
Title:
Email:
   
Location:
Alternate Contact Information
Prefix:
Name (Last, First):
,
Tel/Contact#:
Email:
Location Information
Location Category
Select Location:
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:
Click the button to the right
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/Source:
Request Type Selection







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


Other CC:
Description of Unlawful Discrimination
(Click to expand):

Unlawful discrimination involves unfair treatment because of your race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, disability, age (age 40 or older), or genetic information. Some real examples of unlawful discrimination may include denying computer training to certain employees because of their age, failing to promote certain groups because of their race, or paying someone less based on gender.



ER Complaint - Unlawful Discrimination :




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Instructions...

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

Is this complaint about an employee? + Your Browser does not support SVG
Date of occurrence + Your Browser does not support SVG
(NOTE: Must be within 10 days of filing)
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.
Relief Requested + Your Browser does not support SVG
Indicate the action(s) that would resolve your complaint
Has any conduct been reported to an outside entity? + Your Browser does not support SVG
Attorney, Law Enforcement agency, etc.
Are there concerns that the agency cannot fairly or impartially investigate the complaint? + Your Browser does not support SVG







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