Sample Hearing Request

EEOC Hearings Unit

________________________ District/Field Office

_________________________________________

_________________________________________

_________________________________________

Dear Sir/Madam:

I am requesting the appointment of an Equal Employment Opportunity Commission Administrative Judge pursuant to 29 C.F.R. § 1614.109(g). I hereby certify that either more than 180 days have passed from the date I filed my complaint or I have received a notice from the agency that I have thirty (30) days to elect a hearing or a final agency decision.

My name: _________________________________

Agency

Name &

Address: __________________________________

__________________________________

__________________________________

__________________________________

Agency

Number: __________________________________

In accordance with section 1614.108(g), I have sent a copy of this request for a hearing to the following person at the agency:

Name: __________________________________

Address: __________________________________

__________________________________

__________________________________

__________________________________

Sincerely,

[Your Name]