SEXUAL HARASSMENT CONSENT FORM NAME: ___________________________ SSN: ___ - __ - ____ ADDRESS: ________________________ HOME PHONE: (___) ___ - ____ x_________ ________________________ WORK PHONE: (___) ___ - ____ x_________ GENDER: MALE _____ FEMALE _____ 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 ____________ OTHER (SPECIFY) ________________ ARMS ________________ ALL OF THE ABOVE _______________ WAIST _______________ BUNS ________________ BOOBS _______________ OTHER _______________ 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 PERSONS: ________________________________________________________________________ APPLICANT SIGNATURE: __________________________ DATE: ________________ WITNESS SIGNATURE: ____________________________ DATE: ________________