I certify that the information provided on this document is true and accurate to the best of my knowledge and belief. I understand that such information is subject to verification and further understand that the above information, if misrepresented or incomplete, may be grounds for immediate termination from any ARPA program and/or penalties as specified by law.

I certify that the individual whose signature appears above provided the information recorded on this form.

Worksource Montgomery (WSM) and other entities receiving or administering Workforce Innovation and Opportunity Act (WIOA) funds are prohibited from discriminating on the grounds of race, color, religion, sex, national origin, age, disability, marital status, familial status, and political affiliation against any individual.

 

If you think that you have been subject to discrimination under a WIOA funded program or activity, you may file a complaint within 180 days with the recipient's Equal Opportunity Officer (or person designated as such).

 

WSM EO Officer:
Cynthia Grissom

1801 Rockville Pike, Suite 320

Rockville, MD 20852

Email: cgrissom@worksourcemontgomery.com

 

 

ANTI-HARASSMENT 

 

WSM is committed to maintaining a work environment that is free from discrimination. In keeping with this commitment, we will not tolerate any form of harassment against our employees, vendors, or customers. All customers are expected to avoid any behavior or conduct that could reasonably be interpreted as unlawful harassment of customers or persons, who are involved with the Adult and Dislocated Worker Program.

 

Harassment consists of unwelcome verbal, physical, or visual conduct that is based on a person's protected status, such as gender, color, ethnicity, ancestry, religion, national origin, age, disability, veteran status, citizenship status, or other protected groups status. Harassment includes conduct that denigrates or shows hostility or aversion toward an individual because of his or her protected status or that of his or her relatives, friends, or associates. Sexual harassment deserves special attention. Unwelcome sexual advances, requests for sexual favors, and other physical, verbal or visual conduct based on sex may constitute sexual harassment.

 

If you feel that you have experienced or witnessed harassment, you are to notify the Director of this program immediately, who will take steps to ensure that your report is properly investigated. There will be no retaliation against anyone for reporting harassment, or for cooperating with an investigation of a complaint of
harassment.

 

 

Receipt of Montgomery County's Adult and Dislocated Worker ProgramEqual Opportunity and Anti-Harassment Policies

 

I verify that I have received a copy of the Equal Opportunity and Anti-Harassment Policies and the name and address of the designated Equal Opportunity Officer:

Worksource Montgomery (WSM) will make every effort to provide a professional and positive environment focused on providing career services to customers. Whenever possible, we will address complaints or grievances within 10 business days of submission.

 

Participants are encouraged to communicate program issues first to the staff who can assist in the area of concern. Issues that need to be escalated should be referred to the WSM Director.

 

You may file a formal written grievance as follows:
You have up to 30 days to fle a grievance. Your grievance must be in writing and must contain the following information:

yourname;
mailing address, or other means by which you can be contacted;
identification of individual(s) responsible for alleged issue;
a description of the allegation(s), which must include enough details to determine the jurisdiction of the complaint;
the date(s) the alleged incident(s) took place; and
the complainant's signature or the signature of his/her authorized representative and the date
of signature.
 

You may file your grievance with:

Ernestine Chambers
Director of Performance & Compliance
WorkSource Montgomery Inc.
11510 Georgia Avenue, Wheaton, MD 20902
Email: echambers@worksourcemontgomery.com

 

 You may also file a grievance with:
Nate' Gordon
Deputy Director, Administrative Services
WorkSource Montgomery Inc.
1801 Rockville Pike, Suite 320, Rockville, MD 20852
Email: ngordon@worksourcemontgomery.com

 

Grievance Procedure Timeline

 

1. Within 2 days from the receipt of a grievance, the Director of Performance & Compliance will contact the customer.
2. Within 10 business days of receiving a grievance, the Director of Performance & Compliance will attempt to resolve the matter informally.
3. If a resolution cannot be reached within the initial 10-day period, a formal hearing will be scheduled. The formal hearing provides customers with an opportunity to present any evidence.
4. Within 10 business days of the formal hearing, the WSM Deputy Director will issue a decision. 

 

Appeal

 

If the grieving party does not receive a decision within 60 days of filing the formal grievance, or receives an unsatisfactory decision, the aggrieved has a right to request a review by the Maryland Department of Labor Licensing and Regulation (DLLR).

 

Receipt of Grievance Procedures

 

I verify that I have received a copy of the Grievance Procedures and the names and addresses of the WSM Director of Performance & Compliance and the Deputy Director of Administrative Services:

Parent/Guardian or Other Responsible Adult Signature (if applicant is under 18):

WorkSource Montgomery is an Equal Opportunity Employer / Program. Auxiliary aids and services are available upon request to individuals with disabilities.