Acknowledgement of Receipt - Receipt of Sexual Harassment - Florida

This "Acknowledgement of Receipt - Receipt of Sexual Harassment" is a Florida-specific form released by the Florida Department of Juvenile Justice on September 1, 2017.

Download the form by clicking the link below, fill it out by hand, and mail it as per the guidelines provided by the department or the applicable legal instructions.

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FDJJ 1003.22
Attachment 3
9/2017
DEPARTMENT OF JUVENILE JUSTICE
RECEIPT OF SEXUAL HARASSMENT
ACKNOWLEDGMENT OF RECEIPT
This is to acknowledge that I understand it is my responsibility to read and adhere to the DJJ Policy on
Sexual Harassment and Discrimination and Department of Management Services Personnel Management
System 60L-36.004, Florida Administrative Code regarding Sexual Harassment. If I need assistance on how
to access DJJ policies and procedures or have any questions, I am to contact my supervisor.
Should I have a complaint of sexual harassment and/or need to report an instance of sexual harassment,
I understand that I should contact any Manager/Supervisor, or the Equal Employment Officer in the
Bureau of Human Resources at (850) 717-2654.
I also understand that this signed acknowledgement of receipt will become a permanent part of my official
personnel file.
_______________________________
_________________
Signature*
Print Name
_________________
Date
* Acknowledging receipt of this document in the department’s electronic acceptance system substitutes as your
signature. Provision within the Florida’s Electronic Signature Act of 1996 and the Uniform Electronic Transaction
Act, both provide that digital signatures or attestations may be substituted for the signature, unless otherwise
provided by law (see section 668.004, F.S. and subsection 668.50(7), F.S.).
Please print for your records.
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FDJJ 1003.22
Attachment 3
9/2017
DEPARTMENT OF JUVENILE JUSTICE
RECEIPT OF SEXUAL HARASSMENT
ACKNOWLEDGMENT OF RECEIPT
This is to acknowledge that I understand it is my responsibility to read and adhere to the DJJ Policy on
Sexual Harassment and Discrimination and Department of Management Services Personnel Management
System 60L-36.004, Florida Administrative Code regarding Sexual Harassment. If I need assistance on how
to access DJJ policies and procedures or have any questions, I am to contact my supervisor.
Should I have a complaint of sexual harassment and/or need to report an instance of sexual harassment,
I understand that I should contact any Manager/Supervisor, or the Equal Employment Officer in the
Bureau of Human Resources at (850) 717-2654.
I also understand that this signed acknowledgement of receipt will become a permanent part of my official
personnel file.
_______________________________
_________________
Signature*
Print Name
_________________
Date
* Acknowledging receipt of this document in the department’s electronic acceptance system substitutes as your
signature. Provision within the Florida’s Electronic Signature Act of 1996 and the Uniform Electronic Transaction
Act, both provide that digital signatures or attestations may be substituted for the signature, unless otherwise
provided by law (see section 668.004, F.S. and subsection 668.50(7), F.S.).
Please print for your records.
Save As
Print Form
Reset/Clear Form

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