‘EQUAL EMPLOYMENT OPPORTUNITY COMMISSION INTAKE QUESTIONNAIRE Please lmmediately complete the entre form and return it to the U.S, Equal Banployment Opportunity Commission (EEOC), REMEMBER, a charge of employment diserimination must be fed within the time limits imposed by law, generally within 180 days or in some places 300 days of the alleged discrimination, Upon receipt, this form -vill be seviewollto determine EEOC coverage. Answer all questions as completely as possible, and attach ndditional pages if ‘needed to complete your response(). Ifyon do not know the answer to a question, answer by stating "not Joaown,!* ‘Ia question Is not applicable, write "n/a." Please Print. 4 dawetikcaen ee : or cy hope Numbers: ome: Work: (___*) Call ). Ennnil Address: Sec Male (E] Feule [] DoYouHweaDiscliy? [I¥e ke]No Due of Bi Please answer cach ofthe next three quodtios. j, AreyouHispanicorLating? — []¥es_{JNa (American tndim or Alnsea Native [] Asian] “White fi, Whatisyour Race? Please choose al that ply. D7 Plackor asian Amariszn [] Native Hovalian or Other Paci Islander United States ii, What is your Netional Origin (county of origin or ncesty/)? ‘Please Provide The Name Of A Person We Can Contact If We Are Unable To Reach You: Nemo: Attorney Timothy W. Denne; ‘Relationship:_ Attorney City: Lapeer State:ME Zip Code: 48446 vee) a 2, Lbelieve that Tas discriminated agalus by the following organization(s): (Check those that apply) (C1 Buployment Agency —[[] Other (Please Specify) @ Employer [] Union Orguntzation Contact Safermation (Jf te organization isan exploye, provide the address where you att worked. Ifyou work and provide the address ofthe offic ta which you reported.) Mmore than one employer is involved, atach fiom: home, beck bere LI ailonal sheets. ea Heats OrpusizationName: Ford Motor Conpeny (Also Rapid Global Bisiness Solutions, Inc. RGBSI) on Exhit A County: Wayne 20000 Rotunda Drive Address: ity: Dearborn, ‘States_yor_ Zipt_48124 Phones(___) OSES ERRUCORSEEVE coeande DpTy 5 ‘Type ofBusiness: manufacturer Tob Location iiffrent from Org. Address: Deaeboray Ai 2aKt2™ ® Phone: ‘Human Resources Director or OwnerName: _ Rona Smart ‘Number of Employees in the Organization at All Locations: Please Check (v) One 15-100 © Cior~200 7) 201-500] More than 500 (Fewer Thao 15 Areyou a Federal Employee? []¥es [EINo 3, Your Ewployment Data (Complete as many items as you cen) Job Tile At Hire: Last or Current Pay Rate: tion: Product Engineer Date QuitDischorged: DoteHied: 3-4-2013 Product Engineer Pay Rate When Hire Job Tite at Time of Alleged Diserima ‘Job Applicant, Dete You Applied for Job _ 3-4-2011 Job Title Applied For Product Engineer ‘4. What s the reason (basis) for your claim of employment discrimination? FOR EXAMPLE, if you fel that you were treated worse than someone ele Because ofrace, you should check the box next to Race If yo fel you were treated worse for several reasons, sch as your sex, religion and national origin, you should check all hat apply. if ‘you complained abou discrimination, participated in someone else's complain, or fled a charge of dicrimination, and a regative ‘ation was threalened or taken, you should check te Box next to Retaliston, Chace Cex ClAge C)Disebilty ClNational Origin [Religion ff] Retaliation C}Pregnancy Cl Color (typically « 10s Which type(s) of genti information is involve: diferesce in skin shade within th same rae) C) Genetic Inform (Clie genetic testing Cli. femily medical history (ili. genetic services (genetic services means counseling, education or testing) ‘Ifyou checked color, religion r national origin, please specify: See Attached Explanation (Exhibit 8) ‘you cheaked genetic information, how did the employer obtain the gecetic information? ‘Other reason (basis) for discrimination (Explain). See attached explanation (Exhibit B) e(adand ‘5. What happened to you thnt you believe was discriminatory? th ease attach additional pages if needed. tiles) ofthe person(s) ho (Example: 10/02106 ~ Discharged by Mr John Soto, Prctction Supervisor) A) Date Action: Discharged by Ford and RGBST ‘Nam and Title of Person(s) Responsible: BY Date: Action: Ford (Rona Swart and possibly others) RGRBSI (Kelaey Rossi and possibly ath, ‘Nanie and Title of Persoo(s) Responsible 6. Why do you believe these actions were discriminatory? Please attach additional pages if needed. See attached explanation (Exhibit B) 7. What reason(s) were given to you for the acts you consider discriminatory? By whom? His or Her Job Title? See attached explanation (Exhibit B) 8. Describe who was in the sume or similar sitmation as you and how they were treated. Vor example, who else applied for the ‘same job you did, who else had the same attendance record, or who eke had the same performance? Provide the race, sex, ‘age, national origin, religion, or disability ofthese individuals, if known, and if itelntes to your claim of discrimination. Mor ‘example, if your Complaint alleges race discrimination, provide the race of ench person; if it aloges sex discrimination, provide the sex ofeach pervon; and so on. Use additional sheets if needed. (OF the persons in the same or similar situation as you, who was treated beter than you? A: TullNome ‘Race. s6x-o6e. national origin, religion or disability [Job Title ‘Descriplion af Treatment B. BullName Race, nx. age, national origin. religion or disability [Job Title ‘Dessriplion of TreatmentOF the persons in the same or similar situation as you, who was treated worse than you? a A. Dulane Race sex, age, national origin. religion ordisabliy Job Tile ‘Description of Deatment =a 7 en ‘Descrintion of Trealment (Of the persons inthe same or similar situation as you, Who was treated the same as you? A Eul.Nene ‘Race se. age, national origin raisin. or disability ‘Description of Treaiment ‘B, Bill Name ‘Rone. sex, ape, national origin. religion or disability [Job Title ‘Description of Treatment Answer questions 9-12 only if you are claiming diserimaination baced on disability. If mot, skip to question 13. Please tell ust you have more than one disability. Please add additional pages if needed. 9 Please check all that apply: Yes, thave a disability To not have a dissbility now but I did have one 2 Nocisabitity but the organization eats me as ifT am disabled 20. Whats the disability that you believe isthe reason for the adverse action taken against you? Does this disability prevent or limit you from doing anything? (cg, lifting, sleeping, breathing, walking, caring for yourself, workin, etc) ‘11. Do you use medications, medical equipment or anything else to lessen or eliminate the symptoms of your disability? Yes] Nol] "Yes," what medication, mediesl equipment or other assistance do you use? 12, Did you ask your employer for nny changes or assistance to do your job Deenuse of your disability? Yes[] Nol] IE"YES", when did yom ask? ‘How did you ask (verbally or in writing)? ‘Who did you ask? (Provide fill name and job tle of person) Deseribe the changes or assistance that you asked for: ‘Hovr did your employer respond to your request?13. Are there any witnesses tothe alleged discriminatory incidents? 1tyes, please dentiy them below and tell ms what they will say. Please attach additional poges if needed to complete your response) Fal Name [sob Tie [Address & Phone Number Rona Smart unan Resources Representative Dw? ‘Wiint do you Believe this person will Full Name eb Title [Aatdress & Phono Naber Kelsey Rossi ‘What do you believe this person will tellus? 14, Have you filed n charge previously inthis matter with HROC or another agency? —-Yea["]_ Nol] 15, Ifyou have fled a complaint with another agency, provide name of agency and date of fling: 16, Have you sought help abont this situation from a union, an attorney, or any other source? Ves (| No[-] trie mae nares senso pet yn peed toate tet Steoperye hele tateee, ee ore ae We Plane Nerioayy dee. WGbe Clam oh ee meaeiiaailiegs Actorney Timothy 1 Denes) 110 1, Sap: he Please check one ofthe boxes beloy (o tellus what you would lke us te do withthe information you ae p questionaire. Ifyou would like o file « charge of jb discrimination, you mst dos ede hin 180 days fom the day you eee about the discrimination, or within 300 days fom the day you knew about th dscinnon if ie employers ocated ina plece| ‘where a tte or local govorument agency eforees Ins siilar othe EEOC’ avs. Uyou donot flea charge of dscrimloat Within the dime Timits, you wil lose your rights. Ifyou would lke more information before fling a charge or you bave concerns shout EEOC 's notlying the employer, union, oF employment agency about your charge you may wish fo cheek Box 1. Ifyou want to filen charge, you should sheck Box 2, Box | [[-j ant to talk to an EEOC employes before deciding whether to flea charge. Tundersiand that by checking Wik box, T have not fied a charge wih the BEOC. Talso wnderstand that Tcould lose my rights iT donot flea eharge in tine Box 2 [ !wantto file charge of discrimination, and Tauthorias the EEOC to look ino the isccimination T seribed above. T understand that the EEOC must give the employer, anion, or employment agency that I accuse of discrimination |B) information about the charge, inchiding my name. T also undersland that he EBOC ean only accept charges of job discrimination based on race, color, religion, 62x, national origin, dlsobily, age, genetic information, or retaliation for =! ‘opposing diserimination. : T Neawee bud. Ms 28, AGi me 3 Today's Date ‘Signature FRIVAGY ACT STATEMENT: This frm i coved by be Privacy AatoF 197 Poli Law 91-579. Aas fer reusing esol ua ad he ete we 3, FORM NUMUER/TIPLAVDATE EEOC Inake Questionnaire (22008) 2 AUTHOWTY. 2US.C,§2600e5) 29 USC.§211,29USC $625, 2US.C, 2117) 42 USC SIONS 3. PRINCIPAL PURPOSE. Ths pupos of his qustonie so sali ivomaton eho line a employment tssininon deere whet: he EEOC jiitioncver tne eins, wn rove chege Hingeoueling, a apap, Consian| wit29 CPX 60,126) and 29 CFR 1626s) tke Goeonnng Faces ry suve wsuchage if ioses be Semen ‘4 ROUTINBUSES. EEOC may disclace float fom hs fem aoe ate eal and eda geese nope or eel ay tie Conmisis faeons orf FED becomes ava a iio erin! inven, EEOC may lads inrmetionlcapondens seta t gression lies in response imaes fo pars othe charge, todiiptinay comes investing complains ohn ares eprng fortes a theehare, oto feel apne ning ao rng sty elarance mats, 5: WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND LEVECT ON INDIVIDUAL. FOR NOT PROVIDING INFORMATION, roving hs roan i ohn bt the fee de ay hues the Commision’ investigation aa hg, hel mandala La is fe be awe to provide te rogue iniomatonHIBIT A Organization Name: Rapid Global Business Solutions, Inc. Address: 31791 Sherman Avenue County: Oakland County ‘Type of Business: Workforce Management Number of Employees: Over 100 employees (exact number unknown)EXHIBIT B FACTUAL BACKGROUND. Despite a pristine personnel record, Ford Motor Company (“Ford”) and Rapid Global Business Solutions, Inc. (“RGBSI") terminated me based solely upon my expression of my sincerely held religious beliefs when Ford invited me to make a comment and respond to Ford's statement of its company policy that conflicted with my sincerely held religious beliefs. 1, Thomas Banks, was fired by RGBSI and Ford Motor Company from my position as a Design and Release Product Engineer on Monday August 4, 2014. Around July 23, 2014, I reviewed an article published by Ford pertaining to certain policies. Upon review of the article, it became apparent that some of Ford's policies conflicted with my sincerely held religious beliefs. Ford has an online comment box for employees to submit comments in response to the article. After reading the article, I submitted a comment explaining my objection to Ford's policies based on my sincerely held religious beliefs. Specifically, 1 have a sincerely held religious belief that homosexuality is immoral and also offensive to Christians. Ford's policy of promoting homosexuality, conflicts with my sincerely held religious belief. At Ford’s invitation, I submitted a comment outlining the conflict with my sincerely held religious beliefs. See Exhibit I—Comment Subraitted by Tom Banks. I expressly noted the detrimental effect that Ford’s policy would have on Christians, which included other Christian employees in the ‘company's workplace, On August 4, 2014, I met with Ford HR representative Rona Smart at her request. During the meeting, Ms, Smart sought only to verify that I was the author of a comment submitted to a Ford on-line comment box. (The comment box requested comments pertaining to an article delivered to my Ford e-mail inbox in an email entitled “News to Know”) On Thursday, July 31, 2014, I received a short e-mail from Rona Smart, which read “I would like to meet with you to discuss something that was brought to my attention. We will discuss in more detail on Friday, Thank you.” I was on vacation Friday, so we met on Monday, August 4, 2014 at 8:30 a.m. I'was told at the 8:30 meeting that I allegedly violated Ford Anti- harassment Directive B110, which Rona Smart gave me # copy of, See Exhibit 2. Ms, Smart stid she would be in touch after “Personnel Relations” reviewed this further. I returned to work. Upon arriving home that evening, I received a voice-mail from RGBSI representative Kelsey Rossi (who also attended the 8:30 a.ta, mecting) telling me T was fired and not to retum to work. The companies gave me no warnings, no opportunity for discussion, and no specifics about what part ofthe “Directive” I allegedly violated, After that, RGBSI confirmed that it and Ford were terminating my employment. See Exhibit 3—Emails from RGBSI Representative Kelsey Rossi. RGBSI terminated me for allegedly violating a harassment policy that does not even exist. RGBSI relies on the following language from RGBSI’s policy handbook as the purported basis for firing me: “Similarly, harassment on account of any other protected status, such as sex, age, rave, color, creed, religion, marital status, national origin, ancestry, citizenship, military status, veteran status, disability, genetic information (height and weightin Michigan), and (partnership status, sexual orientation, and alien status in New York City. New York) (for example, conduct or comments which reflect negatively upon or disparage any protected group, even if the conduct or comments are made “in jest” and/or are not directed to any particular individual) is also probibited. If for any reason an employee is not comfortable reporting any incident involving actual or potential harassment or discrimination to Management, he/she may report the incident to James M. Reid IV, Esq., RGBSI’s a added). However, a careful reading of RGBSI’s own policy confirms that its own policies do not even prohibit what it claims is the policy basis for its decision. RGBSI only has a “sexual orientation” policy that applies in New York City, New York, No such policy exists in Michigan, or for Michigan employees. (Similarly, RGBSI has a policy about height and weight harassment in Michigan, that is inapplicable elsewhere.) As seen above, the policy — see the underlined portion — only applies in New York City, New York. Itis undisputed that [ performed my work, live in, and sent my e-mail while in Michigan. ‘Thus, RGBSI terminated me for stated reasons that have no basis in RGBSI policy. MY FIRING CONSTITUTED RELIGIOUS DISCRIMINATION UNDER TITLE VII The termination of my employment constituted unlawful religious discrimination in violation of Title VII of the federal Civil Rights Act 42 USC, Section, 20003 et seq. and the Civil Rights Act of 1991, 42 USC, Section 19812. Based on my sincerely-held religious beliefs, and in a response solicited by Ford Motor ‘Company and open to employees, I expressed an objection to company policy based upon those beliefs. I was fired by RGBSI and Ford Motor Company for my expression of these religious beliefs and my declaration to Ford Motor Company and RGBSI that in essence this promotional program would trample upon and offend the religious beliefs of Christians, which include myself and other Christian employces. This firing violates Title VII of the federal Civil Rights Act of 1964, 42 USC Section 2000e, et seq. (including but not limited to 42 USC Seetion 2000e-2) and the Civil Rights Act of 1991, 42 USC, Section 1981a, which expressly prohibits discrimination against employees on the basis oftheir religion. MY FIRING ALSO VIOLATED THE ANTI-RETALIATION PROVISIONS OF TITLE vu ‘This firing also violates the anti-retaliation provisions of the federal Civil Rights Act, 42 USC Section 2000c-5. Employers are not permitted to retaliate against employees simply because they notify the employer that the employer's actions are discriminating against employees on the basis of their religion. My objection placed Ford Motor Company and RGBSI oon notice that its program constituted a policy assault on the religious convictions of Christians, including myself and other employees of Ford Motor Company.FILING OF EEOC CHARGE It is my intent by filing my claim of discrimination, my explanation of the details thereof and my intake questionnaire to hereby file an EEOC charge against Ford Motor Company and Rapid Global Business Solutions, Inc. for religious discrimination and retaliation. fo 2 80 wx: Tus Bae ‘Thomas Banks Dat7faufiy @ |\ 94 any For this Ford Motor should be thoroughly ashamed. Endorsing and promoting sodomy is of benefit to no one. This topic is disruptive to the workplace and is.an assault on Christians and morality, as. well as antithetical to our design and our survival. Immoral sexual.conduct should not : be a topic for an automotive manufacturer ‘to-endorse or promote. And yes-this is. historic-but not in a. good way. Never in the history of mankind has a culture ‘survived “: that:promotes sodomy. Heterosexual -:- » ‘Behavior créates Ti ife- homosexual behavior : leads to death.EXHIBIT ve AARRee Anti-Harassment “a Directive B-110 at a Glance Corporate Directive Ford Motor Company hasa directive of zero tolerance for: + Sexual harassment + Racial or national odgin harassment + Harassment based on race, religion, color, age, 22% natlanal orlgin, disabllty, sexval orientation, gender Identity or veteran status and protected groups + Retaliation against anyone for making a good-faith complaint of such harassment orfor cooperating in Company investigations ofsuch complaints This Directive protect + All Ford employess + Allinciénendent contractors, teriporary employees and agency employees + Allvisitors to the Ford workplace, such as ventlors and customers ‘Such harassment or retaliation violates Ford Motor Company's Directive B-110; + Regardless of whether itis committed by an employee, customer, vendar, agent, a other third party + Regardlass of the sex, race, cr other charactertstics af the person responsible ~ Regardless of whether the harassment or ratallation Violates or does not violate federal, state orlocal law ‘Violation of Directive 8-110 will resuit in dscipline, up to and Including discharge. Definition of Harassment “Harassment” In this Directive means conduct of harassing nature, whether in the workplace or off-sle, which has the effect of interfering with someone's work performance, ar whleh creates an intimidating, hostils, or offensive working environment. What Is acceptable, amusing, cr inorfensive to some may be unwelcome, abusive, or affensivete others. The follwing is list of examples of conduct that Ford considers to be herassment. Thellst snot Intencled! tobeall-inclusive. ‘Sexual Harassment + Abusive, offensive, or unwelcome sexual conversation, Innuends, jokes, or teasing + Univelcome sexual fltatfon, advances, or propositions: + Explicit demands for sexual favars + Subtle pressure for saxual activity + Offensive, Insulting, or suggestive gestures, leering, sounds or comments + Unwanted physical contact, Including touching, petting, Kissing, hugalna, pinching, orbrushing against anather person + Displaying sexually explicit or suggestive messages through graffiti, clothing, cartoons, photographs, or other terns: ‘Anti-Harassment - HR ONLINE Page I oF 5