Sample request for EEO Counseling

TO: the CREO person for your office which should be posted on the bulletin board@ssa.gov

Cc: to whomever you select as the rep

RE: REQUEST FOR EEO COUNSELING

On or about, XXXXXX, I found out that SSA management in (location) did the following: (fill in the blank)

If they did something nice for someone else and not you, state what happened that was good / what happened that was bad for you and the name(s) of those to whom it happened. Then you state why it didn't happen to you: political affiliation, race, color, religion, national origin, sex, sexual orientation, marital status, age, parental status or disabling condition, Veteran's status, reprisal.

You need to state what exactly you: If you are claiming Veteran's discrimination you need to state you are Veteran. If you are claiming discrimination based on age, you need to give your birth date. If you are claiming discrimination based on your religion, you have to state what your religion is or what management thinks your religion is, etc. In most instances, you will be claiming more than one basis for the alleged discriminatory treatment. If you are claiming reprisal, you need to state when you brought an issue of discrimination before SSA, including if you were representing some one else.

My position is:

My grade is:

My SSN is: (I am providing this because I have been told that my SSN will be used to track my EEO Counseling).

To the best of my knowledge, the responsible management officials who made this decision are __________.

Their position titles and work locations are______________________

My work address is
c/o Social Security Administration
_____________________
_____________________
The Administrative phone number is : __________
The Office FAX number is: ______________
My Home Address is:
My home phone is:
My Cell phone is:
I would like to participate in EEO Alternate Dispute Resolution.
The remedy I seek is an EEO styled posting and
I wish to be represented. My representative is:
My representative is a Social Security Employee.
My representative works in the ?? Social Security Office.
The address is:
The work phone number is:
Their cell phone number is:
I do not wish to remain anonymous.