Sample Notice of
Right to File a Discrimination Complaint
SUBJECT: Notice of Right to File a Discrimination Complaint
FROM: [EEO Counselor]
TO: Jane Doe
This
is to inform you that because the dispute you brought to my attention has not
been resolved to your satisfaction, you are now entitled to file an individual
or class-based discrimination Complaint based on race, color, religion, sex,
national origin, physical or mental disability, age, and/or reprisal. If you file a Complaint, it must be in
writing, signed, and filed within fifteen (15) calendar days after the receipt
of the notice, with any of the following officials authorized to receive
discrimination Complaints.
·
Field
Installation Head
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
·
Agency Director
of Equal Employment
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
·
Agency Head
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
·
Other Official(s)
as designated by the Agency, for example, an Agency Equal Employment
Opportunity Officer, the Hispanic Program Coordinator, the Disability Program
Coordinator, or the Federal Women’s Program Coordinator
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
A Complaint shall be deemed timely if it is received
or postmarked before the expiration of the 15-day filing period, or in the
absence of a legible postmark, if it is received by mail within five days of
the expiration of the filing period.
If
you file your Complaint with one of the officials listed above (other than the
EEO officer), it will be sent to the activity EEO officer for processing. Therefore, if you choose to file your
Complaint with any of the other officials listed above, be sure to provide a
copy of your Complaint to the EEO officer to ensure prompt processing of your
Complaint.
The
Complaint must be specific and contain only those issues either specifically
discussed with me or issues that are like or related to the issues that you
discussed with me. It must also state
whether you have filed a grievance under a negotiated grievance procedure or an
appeal to the Merit Systems Protection Board on the same claims.
If
you retain an attorney or any other person to represent you, you or your
representative must immediately notify the EEO officer, in writing. You and/or your representative will receive a
written acknowledgment of your discrimination Complaint from the appropriate
Agency official.
If
you file a Complaint, you should name _____________________________.
________________________
EEO
Counselor