EQUAL OPPORTUNITY COMPLAINT FORM
For use of this form, see AR 600-20; the proponent agency is DCS, G-1.
PRIVACY ACT STATEMENT
Title 10, USC Section 3013, Secretary of the Army: Army Regulation 600-20, Army Command Policy and
E.O. 9397 (SSN)
To provide a means for filing complaint based on discrimination due to race, color, religion, or national
Voluntary; However, failure to provide all the requested information could lead to rejection of complaint for
5. RACE/ETHNIC GROUP
7. DATE (YYYY/MM/DD)
PART I - COMPLAINT
8a. NATURE OF COMPLAINT. (Give, in as much detail as possible, the basis for your complaint; describe the incident/behavior(s)
and date(s) of the occurrence(s); the names of parties involved, witnesses, and to whom it may have been previously reported; plus,
any additional information that would be helpful in resolving your complaint. Attach additional sheets, as needed.)
8b. REQUESTED REMEDY. (What do you think the final outcome should be?)
have read or have had read to me
this statement which begins on this page (page 1) and ends on page
. I fully understand the contents of the entire
statement made by me. The statement is true. I have initialed all corrections. I made the statement without threat of punishment,
and without coercion, unlawful influence, or unlawful inducement.
(Signature of Person Making Statement)
Subscribed and sworn to before me, a person authorized by law to administer oaths, this
(Signature of Person Administering Oath)
(Typed/Printed Name of Person Administering Oath)
9b. AGENCY RECEIVING COMPLAINT.
I acknowledge receipt of this complaint from
I understand I have 3 calendar days (next drill period for reserve soldiers) in which to refer this complaint to the appropriate
commander of the complainant.
9e. DATE (YYYY/MM/DD)
DA FORM 7279, DEC 2005
EDITION APR 99 IS OBSOLETE.