U. S. Equal Employment Opportunity Commission
EEOC FORM 131-A (11/09)
PERSON FILING CHARGE
THIS PERSON (check one or both)
Claims To Be Aggrieved
Is Filing on Behalf of Other(s)
EEOC CHARGE NO.
FEPA CHARGE NO.
NOTICE OF CHARGE OF DISCRIMINATION
IN JURISDICTIONS WHERE A FEP AGENCY WILL INITIALLY PROCESS
(See the enclosed for additional information)
THIS IS NOTICE THAT A CHARGE OF EMPLOYMENT DISCRIMINATION UNDER
Title VII of the Civil Rights Act (Title VII)
The Equal Pay Act (EPA)
The Americans with Disabilities Act (ADA)
The Age Discrimination in Employment Act (ADEA)
The Genetic Information Nondiscrimination Act (GINA)
HAS BEEN RECEIVED BY
The EEOC and sent for initial processing to
and sent to EEOC for dual filing purposes.
While EEOC has jurisdiction (upon expiration of any deferral requirement if this is a Title VII, ADA or GINA charge) to investigate this
charge, EEOC may suspend its investigation and await the issuance of the Agency's final findings and orders. These findings and orders
will be given weight by EEOC in making its own determination as to whether reasonable cause exists to believe that discrimination has
You are therefore encouraged to cooperate fully with the Agency. All facts and evidence provided by you to the Agency will be
considered by EEOC when it reviews the Agency's final findings and orders. In many cases EEOC will take no further action, thereby
avoiding the necessity of an investigation by both the Agency and EEOC. This likelihood is increased by your active cooperation with the
As a party to the charge, you may request that EEOC review the final findings and orders of the above-named Agency. For such a request
to be honored, you must notify EEOC in writing within 15 days of your receipt of the Agency's final decision and order. If the Agency
terminates its proceedings without issuing a final finding and order, you will be contacted further by EEOC. Regardless of whether the
Agency or EEOC processes the charge, the Recordkeeping and Non-Retaliation provisions of the statutes as explained in the enclosed
information sheet apply.
For further correspondence on this matter, please use the charge number(s) shown above.
Enclosure(s): Copy of Charge
CIRCUMSTANCES OF ALLEGED DISCRIMINATION
See enclosed copy of charge of discrimination.
Name / Title of Authorized Official