===== PAGE 1 ===== Montana state government is committed to providing equal access to employment, programs, services, and activities, and prohibits discrimination and harassment based on race, color, national origin, age, physical or mental disability, marital status, religion, creed, sex, pregnancy, childbirth or a medical condition related to pregnancy or childbirth, sexual orientation, gender identity or expression, political beliefs, genetic information, military service or veteran's status, culture, social origin or condition, or ancestry unless based on a bona fide occupational qualification (BFOQ). State agencies are committed to resolving complaints of discrimination and harassment in a fair, timely, and impartial manner. Employees, applicants, clients, and customers may file a complaint under the state's complaint resolution procedures if they believe they have experienced discrimination, harassment, or retaliation. Complainants are encouraged to use the Department of Administration's complaint form found at http://hr.mt.gov/newresources. Montana state government prohibits retaliation against employees, applicants, clients, and customers who oppose unlawful discriminatory practices, files a discrimination complaint, or participates in a discrimination proceeding, including testifying in court. ## Reporting a Complaint: Montana state government encourages employees, applicants, clients, and customers who believe they have been discriminated against or harassed to contact agency management or the agency's equal opportunity (EO) officer, American's with Disabilities Act (ADA) Coordinator, or human resources (HR) staff. ## Agency Responsibilities: 1. Employees and manager who receive a report of alleged discrimination or harassment shall immediately notify the agency EO officer, ADA Coordinator, or HR staff. 2. Upon receiving a complaint, agency management, with guidance from the agency EO officer, ADA Coordinator, or HR staff, shall take appropriate steps to prevent the alleged conduct from continuing, pending completion of the investigation. 3. The agency EO officer, ADA Coordinator, HR staff, or appropriate management representative will promptly initiate an investigation upon receiving a complaint. ===== PAGE 2 ===== Investigation. 6. Agency management shall take appropriate corrective action if the investigation establishes that an employee has violated the state's EEO, Nondiscrimination, and Harassment Prevention Policy. Agency managers may only inform the complainant that appropriate action has been taken and not the details of any disciplinary action taken. 7. If the investigator finds insufficient evidence to conclude that a policy violation occurred, agency management may inform all parties that no action will be taken, and the complainant's right to file an external complaint. 8. Neither agency management nor any employee will retaliate against any employee for filing a complaint or for participating in any way in a complaint procedure. ## OTHER COMPLAINT FILING OPTION An applicant, client, customer, or employee may concurrently file a complaint of unlawful discrimination with: 1. the Human Rights Bureau, 33 S. Last Chance Gulch, Suite 2, P.O. Box 1728, Helena, MT 59624-1728, (406) 444-4356, (800) 542-0807, Montana Relay Service 711, or 2. the United States Equal Employment Opportunity Commission (EEOC) Seattle Field Office, 909 First Avenue, Suite 400, Seattle, WA 98104-1061, (800) 669-4000, TTY (800)-669-6820, ASL Video (844) 234-5122. The complaint must be filed either: a. within 180 days of the alleged incident; or b. if the employee initiates action to resolve the alleged discrimination in accordance with this procedure or contract grievance procedure, within 300 days of the alleged incident. 3. Service members and veterans who believe they have been discriminated against in employment based on military service or veteran status may contact: a. the Employer Support of the Guard and Reserve at (800) 336-4590; or b. the Veterans' Employment and Training Service (VETS) at (866) 487-2365. Service members and veterans may submit a formal, online complaint with VETS at http://webapps.dol.gov/elaws/vets/userra/1010.asp. ===== PAGE 3 ===== .
Employees, job applicants, and customers may use this form to file an internal complaint based on discrimination or harassment (including a hostile work environment) based on any of the protected classes identified in this form. Individuals should submit this form to the agency where the event is believed to have occurred.
Complainant's Name:
Mailing Address:
Phone:
Complainant's Status:
☐ Employee ☐ Job Applicant ☐ Department Customer
Basis of Complaint:
☐ Race ☐ Color ☐ Genetic Information ☐ Retaliation
☐ Sex ☐ Age ☐ National Origin ☐ Political Belief
☐ Religion ☐ Physical/Mental Disability ☐ Sexual Orientation ☐ Marital Status
☐ Creed ☐ Military Service ☐ Veteran Status ☐ Ancestry
☐ Pregnancy, Child Birth, or a Medical Condition Related to Pregnancy or Childbirth ☐ Gender Identity or Expression ☐ Social Origin or Condition
Name of person you believe discriminated against you: ___ Department or Address: ___ Phone: ___ Date, time, and place of the incident(s): ___ ===== PAGE 4 ===== numbers of any witnesses to the incident(s). Use additional pages, if necessary. Name: ___ Phone: ___ Name: ___ Phone: ___ ## Statement: Please describe the incident(s) as clearly and concisely as possible. Provide as much detail as you can recall, including when and where the events occurred and who said what to whom. Explain why you believe the conduct or treatment was discriminatory. Use additional pages, if necessary. ## Action Sought: Please describe what you would like to see done to correct the situation. ===== PAGE 5 ===== remedial action. I also understand that information may also be disclosed if required by law, rule, regulation, or court order. I affirm that this complaint statement is true, accurate, and complete to the best of my knowledge. Signature of Complainant Date In addition to the internal complaint process, complaints may be filed with the following agencies: (a) Montana Human Rights Bureau, 1625 11th Avenue 33 S. Last Chance Gulch, Suite 2, P.O. Box 1728, Helena, MT 59624-1728, (406) 444-2884 4356, (800) 542-0807, TTY (406) 444-0532 Montana Relay Service 711; or (b) United States Equal Employment Opportunity Commission (EEOC) San Francisco District Office, 350 The Embarcadero, Suite 500, San Francisco, CA 94105-1260, Seattle Field Office, 909 First Avenue, Suite 400, Seattle, WA 98104-1061, (800) 669-4000, TTY (800) 669-6820, ASL Video (844) 234-5122, or (c) in the case of a service member or veteran: 1. the Employer Support of the Guard and Reserve at (800) 336-4590; or 2. the Veterans' Employment and Training Service (VETS) at (866)-487-2365. Service members and veterans may submit a formal, online complaint with VETS at http://webapps.dol.gov/elaws/vets/userra/1010.asp.