EEOC Hearings Unit ____________________________ District/Field Office __________________________________________________ __________________________________________________ __________________________________________________ Dear Sir/Madam: I am requesting the appointment of an Equal Employment Opportunity Commission Administrative Judge pursuant to 29 C.F.R. ยง 1614.108(g). I hereby certify that either more than 180 days have passed from the date I filed my complaint or I have received a notice from the agency that I have thirty (30) days to elect a hearing or a final agency decision. My name: ________________________________________________ ________________________________________________ Agency name & address ________________________________________________ ________________________________________________ Agency No.:________________________________________________ ________________________________________________ In accordance with section 1614.108(g), I have sent a copy of this request for a hearing to the following person at the agency: Name: ________________________________________________ ________________________________________________ Address (if different from above)________________________________________________ ________________________________________________ Sincerely [Name of Appellant]
This page was last modified on November 8, 1999.