Dd Form 2655 - Complaint Of Discrimination In The Federal Government Page 3

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PRIVACY ACT STATEMENT

AUTHORITY: 10 U.S.C. 136; 29 U.S.C. 791, 792, 793, and 795; DoD Directive 1440.1; and E.O. 12106.

PRINCIPAL PURPOSE(S): To establish case records and document the counseling, investigation, and adjudication of complaints of employment

discrimination brought by applicants and current and former DoD employees against the DoD.

ROUTINE USE(S): Records may be provided to EEO officials, hearing examiners, investigators and arbitrators, or by representatives of the Equal

Employment Opportunity Commission and the courts concerning the complaint and appeal. The Blanket Routine Uses found at

apply to these records. The specific routine uses found at

also apply to these records.

DISCLOSURE: Voluntary. However, if the individual does not furnish the information requested, processing the complaint may be delayed or

impaired.

READ INSTRUCTIONS CAREFULLY

This form should be used only if you, as an applicant for Federal employment or a Federal employee, think you have been discriminated against

due to race, color, religion, sex, national origin, age, pregnancy, genetic information, disability, or reprisal by a Federal agency and have

presented the matter for informal resolution to an Equal Employment Opportunity Counselor within 45 calendar days of the date the incident

occurred or, if a personnel action, within 45 calendar days of its effective date.

Your complaint must be filed within 15 calendar days of the date of your final interview with the Equal Employment Opportunity Counselor. If

the matter has not been resolved to your satisfaction within 30 calendar days of your first interview with the Equal Employment Opportunity

Counselor and the final counseling interview has not been completed within that time, you have the right to file a complaint at any time

thereafter up to 15 days after the final interview.

These time limits may be extended if you show that you were not notified of the time limits and were not otherwise aware of them, or that you

were prevented by circumstances beyond your control from submitting the matter within the time limits, or for other reasons considered

sufficient by the agency.

If you need help in the preparation of your complaint, you may contact the Equal Employment Opportunity Counselor who provided you with

your initial counseling, or you may secure help from a representative of your choice.

For complaints filed against the Immediate Office of the Secretary of Defense, the Joint Staff and all activities receiving administrative support

from Washington Headquarters Services, the individuals designated to receive complaints are the Equal Employment Opportunity Officer or the

Director, EEO, Office of the Secretary of Defense. Complaints generated within agencies outside the above designated activities must be filed

with that agency's individual designated to receive complaints of discrimination, i.e., the Chief EEO Counselor.

You may have a representative of your own choosing at all stages of the processing of your complaints.

You will have an opportunity to talk with an investigator and present all the facts which you believe show discrimination. The investigator will

not be under the jurisdiction of the head of that part of the agency in which the alleged discrimination took place.

After the investigation of your complaint has been completed, you will be furnished a copy of the Report of Investigation. You will be given an

opportunity to request a hearing, which will be conducted by an Administrative Judge assigned by the Equal Employment Opportunity

Commission (EEOC). The hearing will be held at a convenient time and place. At the hearing, you may present witnesses and other evidence

on your behalf.

The final decision (in writing) will be made by the head of the agency or his or her designee. If a hearing is held on your complaint, the head of

the agency or the designee will review the decision recommended by the Administrative Judge before making a final decision, and will furnish

you with a transcript of the hearing, a copy of the findings, analysis, and recommended action of the Administrative Judge, along with the

agency's final decision letter.

If you are not satisfied with the final agency decision, you have the right to appeal that decision within 30 calendar days after receipt to the Equal

Employment Opportunity Commission, Office of Federal Operations, P.O. Box 77960, Washington, DC 20013.

If your complaint is based on race, color, religion, sex, national origin, pregnancy, genetic information, disability, or reprisal, you may file a civil

action in an appropriate U.S. District Court within 90 days of receipt of the agency's decision or, if you elect to file an appeal with the

Commission, you may still file a civil action in a Federal District Court within 90 days of the Commission's decision if you are dissatisfied with

the decision.

If your complaint is based on race, color, religion, sex, national origin, pregnancy, genetic information, disability, or reprisal, you may file a civil

action in an appropriate U.S. District Court if you have not received a final agency decision within 180 days of filing your complaint with the

agency or if you have not received a final Commission decision within 180 days of filing your appeal with the Commission's Office of Federal

Operations.

DD FORM 2655, JUN 2012

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