Pers 497 Form – Fill Out and Use This PDF

Pers 497 Form is a form that students can fill out if they want to take credit for any classes they're taking at The University of North Carolina at Pembroke.

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Pers 497 Form PDF Details

The College of Saint Rose offers a Pers 497 form to assess and document a student's individual experience in the learning community. The form is designed to be filled out by both the student and professor, and can be used to provide feedback that will help improve the quality of the learning community experience for all students. The College of Saint Rose values your feedback, and we hope you will take the time to fill out this form honestly and thoughtfully.

You may find information regarding the type of form you need to prepare in the table. It will show you how much time it takes to finish pers 497 form, exactly what parts you will need to fill in, and so forth.

Question	Answer
Form Name	Pers 497 Form
Form Length	2 pages
Fillable?	Yes
Fillable fields	75
Avg. time to fill out	15 min 34 sec
Other names	OIG, Discriminatory, EEO, SSN

12

Form Preview Example

Texas Department of Criminal Justice

EEO COMPLAINT FORM

Complainant Information (Person Complaining)

Name:

Last

First

MI

Title:

Work Shift:

Home Mailing

Address:

Street Address

City

State

Zip

Payee ID:

Unit or Dept:

Schedule Card:

Home or Cell

Phone #:

(Area Code)

Name of Warden or Department Head:

Email Address:

Respondent Information (Person Complained Against)

Name:

Title:

Unit or Dept:

Date(s) of Discriminatory Event:

Earliest:

Latest:

Are you complaining about:

(Check)

Slurs or Hostile Epithets?

Yes

No

If yes, explain:

Color Discrimination?

Yes

No

If yes, identify your color:

Race Discrimination?

Yes

No

If yes, identify your race:

National Origin Discrimination?

Yes

No

If yes, identify your national origin:

Gender Discrimination?

Yes

No

If yes, identify your gender:

Male

Female

Discourteous Conduct of a

Yes

No

Sexual Nature?

Sexual Harassment?

Yes

No

Age Discrimination?

Yes

No

If yes, identify your date of birth:

Disability Discrimination?

Yes

No

If yes, identify your disability:

EEO Retaliation?

Yes

No

If yes, retaliation for what EEO activities?

Genetic Information?

Yes

No

If yes, specify:

Religion?

Yes

No

If yes, identify your religious belief:

Other?

Yes

No

If yes, specify:

Complainant’s Initials: _________

Date:

MM/DD/YYYY

PERS 497 (09/21)

STATEMENT

(Attach additional pages as needed. Number, sign, and date each additional page.)

1. Include specific details such as “who, what, when, and where” for each alleged event of your complaint.

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

2.List name(s) of all known witnesses and provide, in your own words, a summary of what the witness(es) may testify about the alleged event.

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

3. List name(s) of all individuals to whom you reported the alleged event and the date(s) you reported the alleged event.

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

The foregoing statement contains all of my complaint(s), all names of witnesses, and all names of individuals to whom I reported the alleged event. This complaint includes this two-page form and ______ additional pages attached,

numbered, signed, and dated. I understand that in addition to any action the TDCJ may take in this matter, I may have filing rights with the Texas Workforce Commission, Civil Rights Division (TWC-CRD) and the U.S. Equal Employment Opportunity Commission (EEOC). I also understand that I may contact the Office of the Inspector General (OIG) if I elect to pursue criminal charges relating to this complaint.

Complainant Signature: ___________________________________	Date: _____________________
	MM/DD/YYYY

Note to Employee: With few exceptions, you are entitled upon request: (1) to be informed about the information the TDCJ collects about you; and (2) under Texas Government Code §§ 552.021 and 552.023, to receive and review the collected information. Under Texas Government Code § 559.004, you are also entitled to request, in accordance with TDCJ procedures, that incorrect information the TDCJ has collected about you be corrected.

PERS 497 (09/21)

How to Edit Pers 497 Form Online for Free

Our PDF editor makes submitting files stress-free. It is quite convenient to enhance the Pers 497 Form form. Stick to the next actions if you would like do it:

Step 1: Click on the "Get Form Here" button.

Step 2: Now you are on the file editing page. You may enhance and add content to the form, highlight specified content, cross or check certain words, include images, insert a signature on it, get rid of needless fields, or take them out altogether.

The next few segments are what you will have to fill out to have the prepared PDF document.

SSN spaces to complete

You need to type in the required information in the Check, Yes, Yes, Yes, Yes, Yes, If, yes, explain If, yes, identify, your, color If, yes, identify, your, race If, yes, identify, your, national, origin If, yes, identify, your, gender Male, Female, Yes, and Yes field.

step 2 to filling out SSN

The program will require you to insert particular relevant details to conveniently complete the section about, the, alleged, event

stage 3 to entering details in SSN

It's essential to describe the rights and obligations of both sides in box Date, and MM, DD, YYYY

Date, and MMDDYYYY in SSN

Step 3: Choose the Done button to confirm that your finished form is available to be transferred to any electronic device you pick out or sent to an email you specify.

Step 4: Come up with a duplicate of each file. It can save you time and enable you to avoid concerns in the long run. Keep in mind, the information you have isn't going to be shared or monitored by us.

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