Equal Employment Opportunity

THIS SITE IS INTENDED FOR REPORTING ALLEGATIONS OF DISCIMINATION COMPLAINTS
INVOLVING UNCLASSIFIED INFORMATION


DATA REQUIRED BY THE PRIVACY ACT OF 1974

ROUTINE USES: Information is used for official purposes within the Department of the Navy; to answer complaints or respond to requests for assistance, advice, or information; by Members of Congress and other Government agencies when determined by the Equal Employment Opportunity Office to be in the best interest of the DoN. Department of the Navy blanket routine uses also apply.

AUTHORITY Title 29 CFR 1614; Title VII of the Civil Rights Act of 1964; SECNAVINST 5354.2; SECNAVINST 12250.6A; SECNAVINST 5350.16A; DON Discrimination Complaints Manual; OPNAVINST 5354.1F ; COMSCINST 5370.4B; 10 u.s.c § 1561; SECNAVINST 5300.26D; and 5 C.F.R. 1614.105 (a) (1)


PART I - YOUR INFORMATION
You must provide our office with your disclosure election.  Your selection of one of the three filing options below implies you have reviewed the provided information and understand the choice you are making.  If you have any questions concerning this, you may phone the MSC Hotline at 1-757-341-3310.  Please keep in mind that your decision to elect anonymity may limit our ability to conduct an inquiry, if one is warranted, or to appropriately address your issue.  In the event our office needs to contact you for additional information or clarification, please provide an e-mail or physical address and/or telephone number where you feel comfortable in accepting our contact.  Your complaint cannot be processed without your election below.

If you choose to remain anonymous, your anonymity is only protected during the informal stage of the complaint process and only if you are not alleging discriminatory harassment, including sexual harassment. Note: Please be advised that anonymity is not protected in cases of statements made to the assigned EEO Counselor with respect to waste, fraud, abuse, security compromise and the intent to commit bodily harm, either to yourself or others. In such instances, this office has the obligation to notify the appropriate authorities. Anonymity will also not be protected in cases involving allegations of sexual harassment.

ANONYMOUS

WAVE MY RIGHT ANONYMITY


First Name:
Last Name:
Employee Status:
Assigned MSC Organization:
Other Agency or Office:
(If not a MSC employee, state where you work)
Component/Office:
Job Title/Series/Grade:
Are you an employee covered by a collective bargaining agreement:
Yes       No
Mailing Address:
City & State:
Zip/Postal Code:
E-mail Address:
Home Telephone:
Best contact time:
Work Telephone:
Best contact time:
Mobile Telephone:
Best contact time:

PART II - ALLEGATION DETAILS
Use this section to provide details of your allegation(s). Please clearly state the subject of your complaint, (applicable MSC office, ship or component, personnel, and/or program affected), and provide names, dates, times, and locations in the applicable fields. Also state how you became aware of the problem, efforts made thus far to correct the problem, and let us know what other offices you have contacted for assistance, and if you have outstanding complaints with those offices. If you have supporting documentation or chronologies, it would be helpful to enclose those documents along with your complaint filing. You will be given an opportunity to upload documents for submittal at the end of this form.
WHAT IS YOUR COMPLAINT ABOUT?
Select alleged issue:
If you selected "Other" please specify:
WHAT IS YOUR BASIS?
Select Alleged Basis: (Select All Apply)
Race
Color
Religion
National Origin
Sex
Age
Disability
Genetic Information (GINA)
Reprisal
Other
If you selected "Other" please specify:
RESPONSIBLE MANAGEMENT OFFICIAL(S) (RMO) - WHO COMMITTED THE ALLEGED DISCIMINATION? WHAT MSC PROGRAM OR OFFICE IS INVOLVED?
RMO's Status
RMO's Rank/Title/Grade
RMO's First Name:
RMO's Last Name:
MSC Component or Program
(Spell out acronyms)
MSC Organization or Office Affected:
(Spell out acronyms)
RMO's Status
RMO's Rank/Title/Grade
RMO's First Name:
RMO's Last Name:
MSC Component or Program
(Spell out acronyms)
MSC Organization or Office Affected:
(Spell out acronyms)
RMO's Status
RMO's Rank/Title/Grade
RMO's First Name:
RMO's Last Name:
MSC Component or Program
(Spell out acronyms)
MSC Organization or Office Affected:
(Spell out acronyms)
ALLEGATION DETAILS (WHAT, WHEN, HOW, AND WHY):
Provide a summary of your complaint, to include an event chronology, if appropriate
WHAT IS THE RESOLUTION YOU ARE SEEKING?

PART III - ALTERNATIVE DISPUTE RESOLUTION (ADR)
ADR is a term used to describe a variety of approaches to resolving conflict rather than traditional adjudicatory methods or adversarial methods. The mediation process is an informal one that uses a neutral third party known as a mediator to facilitate the parties' resolution of the dispute. The mediator has no power to make a decision or force one on any party; instead, the mediator works with all parties to reach a voluntary agreement of their own making.
I wish to use the Alternative Dispute Resolution (ADR) Process.
I wish to use Traditional Pre-Complaint Counseling.

PART IV - OTHER ACTIONS YOU ARE TAKING
Please indicate in this section if you have filed your complaint with any other organization, to include other EEO offices, and your Congressperson. If you have contacted other entities, clearly identify the agency, office, or command, and provide your understanding of the current status of your matter. If you have received any responses from those office(s), provide our office with a copy.
Yes       No
Yes       No

PART V - CERTIFICATION
Please indicate your response to the certification below. If you have any questions about what this certification means, do not hesitate to contact the MSC EEO Office at 1-757-341-3310 or via e-mail at MSC_EEO@navy.mil:
I certify that all of the statements made in this complaint are true, complete, and correct, to the best of my knowledge.  I understand that a false statement or concealment of a material fact is a criminal offense.

PART VI - DOCUMENT UPLOADS & SUBMITTAL
If you have supporting documentation that you wish to provide with this complaint form, please use the 'Upload Document' field below. Do not send classified documents using this unclassified internet system. We recommend that you scan your documents together into one electronic file, not to exceed 5 MB in file memory size. Please coordinate with our office by calling 1-757-341-3310 if you wish to send a larger file or additional documents.
Upload Document:  

THIS SITE IS INTENDED FOR REPORTING ALLEGATIONS OF DISCIMINATION COMPLAINTS
INVOLVING UNCLASSIFIED INFORMATION