Notice of
Appeal - Agency
to the Equal Employment Opportunity Commission Office of Federal Operations |
1. Ageny (please print or type): |
2. Address: |
3. Name of agency representative: |
4. Telephone (including area code):
E-mail address: |
5. Name, address. telephone no. of complainant: Complainant's Social Security No.: |
6. If the complainant is represented, name, address, and telephone no.
of representative: |
7. Agency complaint number: |
8. Name of Administrative Judge, District/Field Office location, and EEOC
Hearings U nit No.: |
9. Date of agency final action (include a copy): |
10. T o your knowledge, does the complainant have any appeals
pending at OFO? If so, please indicate the EEOC Appeal Nos.:
|
11. Signature of agency representative:
Date: |
|
FOR EEOC USE ONLY: OFO DOCKET NO.: |
This page was last modified on July 18, 2005.