Sexual Harassment Consent Form


NAME ___________________________   SOCIAL SECURITY NUMBER__________

ADDRESS ________________________   HOME PHONE _____________________

        ________________________   WORK PHONE _____________________

MALE _________  FEMALE _________   OTHER __________________________

     SEXUAL PREFERENCE:

     MALE-FEMALE _______________   FEMALE-FEMALE __________________

     MALE-MALE _________________   HUMAN-ANIMAL ___________________

     ALL OF THE ABOVE __________   NONE OF THE ABOVE ______________

     OTHER (SPECIFY) ______________________________________________

I CONSENT TO THE FOLLOWING FORMS OF SEXUAL HARASSMENT:

SALUTORY GREETING ______________       HEAVY BREATHING ON:

OCCASIONAL COMPLIMENTS _________              NECK ________________

EYE-TO-EYE CONTACT _____________              EAR _________________

EYE-TO-BUST CONTACT ____________              OTHER _______________

PINCHING/RUBBING _______________

GROPING ________________________       HANDS ALLOWED ON:

HEAVY GROPING __________________              SHOULDER ____________

                                              WAIST _______________

                                              ARMS ________________

                                              BUNS ________________

                                              BOOBS _______________

OTHER (SPECIFY) ________________              OTHER (SPECIFY BELOW)

ALL OF THE ABOVE _______________              _____________________

I WILL _____ WILL NOT _____

1. ASSIST IN THE PROCUREMENT OF VARIOUS POTIONS, LOTIONS, AND
   OTHER PRODUCTS TO BE USED DURING MY SEXUAL HARASSMENT.

2. ASSIST IN THE PROCUREMENT AND MAINTENANCE OF VARIOUS TYPES OF
   PARAPHERNALIA TO BE USED DURING MY SEXUAL HARASSMENT.

3. PARTICIPATE IN TRAINING DEMONSTRATIONS.

4. CLEAN UP.

5. SERVE POST-HARASSMENT REFRESHMENTS (LIMITED TO COFFEE, SOFT
   DRINKS, CIGARETTES, COOKIES, ETC.)

I WILL ACCEPT SEXUAL HARASSMENT FROM THE FOLLOWING: _______________

___________________________________________________________________

SIGNATURE: ______________________________    DATE: ________________

(NOTE: A NEW CONSENT FORM MUST BE FILED WITH THE PERSONNEL OFFICE
       WHENEVER ANY OF THE ABOVE INFORMATION CHANGES)