Employee Relation Intake Form

Confidentiality Notice

This document contains confidential information and is intended for authorized recipients only; its contents should not be disclosed, reproduced, or distributed without proper authorization.

Requestor Name

Date of Report

mm/dd/yyyy

Requestor's Department

Requestor's Email

Requestor's Phone Number

Regarding Employee

Regarding Employee's Hire Date

mm/dd/yyyy

Regarding Employee Classification

If Other, please explain:

Office of Equal Employment and Title IX Notice

If your concern is an EEO concern, please submit your concern to titleixcoordinator@unlv.edu

Description of Concern

Provide as much detail as possible (date of concern, location of concern, what occurred, who was involved, witnesses, etc.)

Send me a copy of my responses

Report Abuse