Get the free EEOC Form 5 (11/09) Agency(ies) Charge No(s): Charge Presented To: CHARGE OF DISCRIM...
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EEOC Form 5 (11/09) Agency(IES) Charge No(s): Charge Presented To: CHARGE OF DISCRIMINATION FPA This form is affected by the Privacy Act of 1974. See enclosed Privacy Act Statement and other information
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How to fill out eeoc form 5 1109
How to fill out eeoc form 5 1109:
01
Start by carefully reading the instructions provided with the form. These instructions will guide you through the process of filling out the form correctly.
02
Begin by providing your personal information, such as your name, address, phone number, and email address. Make sure to fill out all the required fields accurately.
03
Identify the employer or agency against whom you are filing the complaint. Provide their name, address, and contact information.
04
Clearly state the nature of the discrimination or retaliation complaint you are filing. Explain the details of the incident, including dates, times, locations, and any witnesses involved.
05
If applicable, explain any attempts you made to resolve the issue before filing the complaint. Include dates and details of any conversations or actions taken.
06
Provide information on any other agencies or organizations to which you have filed a complaint related to the same incident. Include dates, case numbers, and contact information for these agencies.
07
Sign and date the form to certify that the information provided is accurate to the best of your knowledge.
08
Retain a copy of the completed form for your records before submitting it to the appropriate EEOC office.
Who needs eeoc form 5 1109:
01
Individuals who believe they have experienced discrimination or retaliation in the workplace may need to use eeoc form 5 1109.
02
Employees who have faced unfair treatment based on their race, color, religion, sex, national origin, disability, or age may require this form to file a complaint with the Equal Employment Opportunity Commission (EEOC).
03
Employers or agencies against whom the discrimination or retaliation complaints are filed may also need to be aware of and respond to the eeoc form 5 1109.
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