Eeoc Form 131-A - Notice Of Charge Of Discrimination printable pdf download

Eeoc Form 131-A - Notice Of Charge Of Discrimination

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

(FEP Agency)

and sent to EEOC for dual filing purposes.

The

(FEP Agency)

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

occurred.

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

Agency.

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

Race

Color

Sex

Religion

National Origin

Age

Disability

Retaliation

Genetic Information

Other

See enclosed copy of charge of discrimination.

Date

Name / Title of Authorized Official

Signature

Eeoc Form 131-A - Notice Of Charge Of Discrimination

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