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EEOC Form 5 2009-2024 free printable template

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EEOC Form 5 (11/09)Agency(IES) Charge No(s):Charge Presented To:CHARGE OF DISCRIMINATIONFEPAThis 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 discrimination charge form


How to fill out form 5 charge:

Begin by carefully reading the instructions provided on the form.
Provide your personal information accurately, including your full name, address, contact details, and any other information required.
Fill in the specific details related to the charge, such as the date and location of the incident, the nature of the charge, and any additional relevant information.
If there are sections for witness statements or additional comments, make sure to provide the necessary information in those sections.
Double-check all the information you have filled out to ensure accuracy and completeness.
Finally, sign and date the form where indicated, certifying that the information provided is true to the best of your knowledge.

Who needs form 5 charge:

Individuals who have been involved in a legal situation where a charge needs to be filed.
Law enforcement agencies or legal authorities responsible for documenting charges against individuals.
Prosecutors or attorneys who are preparing legal cases against individuals.
Courts or judicial bodies that require charges to be properly documented for legal proceedings.
Any person or entity involved in legal proceedings where charges need to be submitted, documented, and recorded accurately.

Who needs a Charge of discrimination?

This form is used by individuals who believe that they are discriminated at their work place due to their race, sex, religion, sexual orientation or other factors. The charge of discrimination is the first step before filing a job discrimination lawsuit.

What is the Charge of discrimination for?

This document contains a very important information which is required by the US Equal Employment Opportunity Commission. This includes the personal information about the complainant and type of discrimination. This form triggers the investigation of the individual’s case.

What documents must accompany the Charge of discrimination?

As a rule, this form is not accompanied by other documents. You may need to provide additional documents after filing this one.

Does the Charge of discrimination have a validity period?

The document must be filed as soon as the discrimination took place and not later than 180 days after the incident.

What information must be provided in the Charge of discrimination?

While completing the form, the complainant has to add the following information:

  • Name of the State or Local Agency
  • Name, street address, city, phone number, date of birth of the complainant
  • Name, street address, number of employees, phone number of the employer, labor organization, employment agency, etc. who discriminated
  • Type of discrimination (check the right box: race, retaliation, color, sex, age, religion, disability, national origin, other)
  • Date the discrimination took place

The complainant and the charging party also have to sign and date the charge.

The charge of discrimination also must be certified by the notary public.

What do I do with the form after its completion?

The filled out and signed form has to be filed with the US Equal Employment Opportunity Commission.

Video instructions and help with filling out and completing eeoc discrimination charge form

Instructions and Help about eeoc blank form 5

Well you want to provide as much information as you can to the agency investigating your case whether it be the equal employment opportunity commission or at the state level the Pennsylvania Human Relations Commission some of the most important information to provide to either of these agencies would include witnesses with first-hand knowledge so for example if your claim is sexual harassment and you have colleagues who witnessed the sexual harassment you would want to provide the investigating agency with the name and contact information of the witnesses with first-hand knowledge you would also want to provide information to the investigating agency that details your bona fide performance on the job performance reviews merit awards salary increases anything to show that you were performing well on the job and that the company's decision to discharge is a pretext for either some form of unlawful discrimination or retaliation

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Form 5, also known as a Statement of Charges, is a form required to be filed with the National Labor Relations Board (NLRB) by employers who are charged with violating the National Labor Relations Act (NLRA). The NLRA protects the rights of employees to organize, bargain collectively, and engage in other protected activities.
The deadline to file Form 5 in 2023 is April 15th, 2023.
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