Ngb Form 333 PDF Details

At the core of maintaining fair treatment and equality within the Army and Air National Guard stands the NGB Form 333, a document meticulously designed to address allegations of discrimination. Dedicated to Army and Air National Guard members serving in Title 32 status, including National Guard technicians in a military pay status, this form embarks on capturing details necessary for lodging a discrimination complaint. Whether the discrimination is based on race, color, national origin, religion, sex, gender, sexual orientation, or stems from retaliation against those who have earlier engaged in discrimination complaint processes, this form provides a structured pathway for voicing concerns. Prompting complainants to file within 180 days from the incident, it subtly underlines the seriousness with which the National Guard tackles such issues. By requiring detailed information about the complainant, the accused, and the nature of the discrimination or harassment, the form is thorough in its approach to ensure that every grievance is heard and addressed appropriately. Moreover, the accompanying instruction to submit this form to one’s EO State Representative or unit commander highlights the importance of following proper channels to seek justice, reinforcing the National Guard’s commitment to maintaining an environment where every member’s rights are protected.

QuestionAnswer
Form NameNgb Form 333
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesngb 333, form complaint national guard, form 333 national, ngb form 333

Form Preview Example

Page 1 of 4

Discrimination Complaint in the Army and Air National Guard

 

 

(SEEM Use Only)

Filing State/Territory:

 

 

 

For use of this form see CNGBM 9601.01, the proponent agency is NGB-EO.

 

 

NGB Case Tracking Number:

 

 

 

 

 

 

 

 

 

 

 

PRIVACY ACT STATEMENT

 

 

 

 

IRR

Date: _________________

Authority: 42 U.S.C., Chapter 21, Subchapter V

 

 

 

 

 

 

 

 

 

 

 

FRR

Date: _________________

Principal Purpose: To document allegations of discrimination in the National Guard (NG)

 

 

 

 

 

 

 

 

 

 

 

 

ADR

Date: _________________

Routine Uses: None

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disclosure: Voluntary. However, failure to complete all portions of this form could affect the timely processing, or result in the rejection or dismissal of your complaint.

INSTRUCTIONS

PART I - TO BE COMPLETED BY COMPLAINANT

Submit to Your EO State Representative

All NG members serving in Title 32 status, to include NG technicians in a military pay status who believe they have been discriminated against based on race, color, national origin, religion, sex-gender, or sexual orientation, or who believe they have been the victim of sexual harassment, or of reprisal for prior engagement in the discrimination complaint process or related activity, may file a request to resolve discrimination allegations.

You are encouraged to discuss the complaints with and to seek assistance from your immediate supervisor, unit commander, members of the chain of command or EO office staff. Fill out Part I of this form and file the complaint within 180 days of the date of the alleged discrimination or the date that you became aware of the discriminatory event or action. The complaint should be filed with the unit commander (if the commander is not the alleged discriminating official) or with your unit EO representative. You may file with any other commander in the chain of command, the Adjutant General, the National Guard Bureau, or Inspector General Office. However, regardless of where the complaint is filed, it will be referred to the lowest applicable command level for action.

1. COMPLAINANT

 

a.NAME (Last, First, MI)

 

 

 

 

b. RANK

c. COMPONENT (ARNG/ANG)

d. POSITION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.SEX-GENDER (M/F)

 

3. RACE

 

4. NATIONAL ORIGIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. HOME ADDRESS (Including Zip Code)

 

 

 

 

6. TELEPHONE NUMBERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. BUSINESS

 

 

 

b. HOME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. ACTIVITY OR UNIT IN WHICH ALLEGED DISCRIMINATION OCCURRED

 

8. ARE YOU

(Check One)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART TIME MILITARY MEMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AGR TITLE 32/ADOS TITLE 32

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPLICANT FOR NG/AGR MEMBERSHIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORMER MILITARY MEMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BENEFICIARY OF NG

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.ALLEGED DISCRIMINATING OFFICIAL (ADO)

a. NAME (Last, First, MI)

b.RANK/TITLE

 

10. REPRESENTATIVE

(If any)

 

 

 

 

 

 

 

 

a. NAME (Last, First, MI)

 

 

 

b. ADDRESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. CHECK BELOW THE BASIS (Reasons) FOR ALLEGED DISCRIMINATION

R

RACE (Check Your Race)

 

Black or African American

 

White

 

American Indian/Alaska Native

C COLOR (State Your Color)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L RELIGION (State Your Religion)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S

SEX-GENDER (Sexual Harassment) (Check Your Gender)

 

 

 

Male

 

Female

 

 

 

 

X

SEXUAL ORIENTATION (Specify)

 

 

 

 

 

 

 

Asian Native Hawaiian/Pacific Islander

O REPRISAL (Based Upon EO Activity)

N NATIONAL ORIGIN (State Your National Origin or National Group) (Specify)

Yes

No

NGB FORM 333, 20171128

Page 2 of 4

12. CHECK FOR SPECIFIC ALLEGATIONS AND ISSUES

 

 

Appointment/Enlistment

 

Evaluation/Appraisal

 

Reassignment

 

 

Assignment of Duties

 

Harassment

 

Retirement

 

 

 

 

 

 

Awards/Decorations

 

a. Non-Sexual

 

Time and Attendance

 

 

 

 

 

 

Disciplinary Action

 

b. Sexual

 

Training/Education

 

 

 

 

 

 

 

 

 

 

 

 

 

Duty Hours

 

Promotion/Non-Selection

 

Other

 

 

 

 

 

 

 

13.STATE ALLEGATION AND ISSUES (Explanations, background, and evidence can be attached as supporting material; they are NOT issues.)

Issues: A. Number each issue.

B. Briefly list the alleged act of discrimination, the basis, and the date(s) it took place.

C. Indicate the name(s) of the alleged discriminating official(s) (ADO).

SAMPLE: I was discriminated against on (date) on the basis of (Race, Religion, or other basis) when (name the ADO) and briefly list the discriminatory event(s) or personnel action(s). Attach additional blank sheets, if necessary.

1.

2.

3.

14. WHAT CORRECTIVE ACTION DO YOU WANT TAKEN TO RESOLVE YOUR COMPLAINT?

15a. SIGNATURE OF COMPLAINANT

15b. DATE

16. OFFICIAL RECEIVING COMPLAINT

a. NAME

b. TITLE

c. SIGNATURE

d. DATE

NGB FORM 333, 20171128

Page 3 of 4

PART II - COMPLAINT MANAGEMENT PROCESSING

 

 

 

 

 

 

 

 

 

 

 

TO BE COMPLETED AT THE LOWEST APPLICABLE COMMAND LEVEL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETE AS APPROPRIATE

 

 

 

 

 

 

 

 

 

 

 

 

 

1. WHEN DID YOU RECEIVE THE COMPLAINT?

 

DATE (YYYY/MM/DD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. WAS THE COMPLAINT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

 

Accepted

 

 

 

 

All

 

 

 

In Part

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b.

 

Referred

 

 

 

 

All

 

 

 

In Part

TO WHOM?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c.

 

Dismissed

 

 

 

 

All

 

 

 

In Part

(State Reason)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.AFTER REVIEW OF THE LEADERSHIP INQUIRY REPORT I FIND THAT YOUR ALLEGATIONS ARE:

 

Substantiated

 

 

Unsubstantiated

 

Discrimination Undetermined

4.DID YOUR NOTICE OF PROPOSED RESOLUTION (NPR) CONCUR WITH THE FINDINGS OF

THE INQUIRY OFFICIAL?

 

Yes

No

 

 

 

 

 

5. NAME/DATE NEXT HIGHER LEVEL COMMANDER REVIEWED NPR:

 

b. DATE (YYYY/MM/DD)

 

 

a. NAME (Last, First, MI)

 

 

 

 

 

 

 

 

 

6. DID THE JUDGE ADVOCATE REVIEW THE CASE?

 

DATE (YYYY/MM/DD)

 

 

 

Yes

No

 

 

 

 

 

 

 

 

7. DID THE SEEM REVIEW THE CASE?

No

DATE (YYYY/MM/DD)

 

 

 

Yes

 

 

 

 

 

 

 

 

 

 

 

 

8. DID THE ADJUNTANT GENERAL (or designated representative) REVIEW THE CASE?

DATE (YYYY/MM/DD)

 

 

 

Yes

No

 

 

 

9. DATE YOU MET WITH MEMBER AND PROVIDED THEM WITH NPR:

 

DATE (YYYY/MM/DD)

 

 

 

 

 

 

10. COMPLAINANT'S ELECTION TO THE NPR'S PROPOSED RESOLUTION AND REMEDY:

 

 

 

[

] Accept the Proposed Resolution and Remedy.

 

 

 

 

[

] Withdraw my State Informal Resolution Request.

 

 

 

 

[

] File a NGB Formal Resolution Request

 

 

 

 

 

 

 

 

 

a. SIGNATURE OF COMPLAINANT

 

b. DATE (YYYY/MM/DD)

 

 

 

 

 

 

11. THIS FORM, THE NPR, THE LEADERSHIP INQUIRY REPORT, AND ANY ACCOMPANYING

DATE (YYYY/MM/DD

 

 

DOCUMENTATION WAS FORWARDED TO NGB-EO-CMA ON:

 

 

 

 

 

 

 

 

 

12. REMARKS:

 

 

 

 

10a. SIGNATURE OF COMMANDER

10b. DATE (YYYY/MM/DD)

NGB FORM 333, 20171128

Page 4 of 4

 

 

 

 

PART III - NGB FRR PROCESSING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FOR NGB-EO-CMA USE

 

 

 

 

 

 

 

 

ONLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. DATE FRR WAS RECEIVED FROM THE STATE:

 

 

 

 

 

 

 

 

 

 

DATE (YYYY/MM/DD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. PRELIMINARY REVIEW OF NGB FRR:

 

 

 

 

 

 

 

 

 

 

 

ACCEPT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISMISS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REMAND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

IF ACCEPTED:

DATE INVESTIGATION REQUESTED:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE INVESTIGATION OFFICER (IO) APPOINTED:

 

 

 

 

 

 

 

 

 

 

 

NAME/RANK OF IO:

 

 

 

 

 

 

 

CONTACT INFORMATION FOR IO: EMAIL:

 

 

 

 

DATE INVESTIGATION WAS COMPLETED:

 

 

 

 

 

 

 

 

OFFICE PHONE:

 

 

 

 

 

 

 

 

 

 

CELL PHONE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE REPORT OF FINDINGS RECEIVED:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE NGB NPR ISSUED:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

IF DISMISSED:

DATE NOTICE OF PROPOSED DISMISSAL SENT:

 

 

 

 

 

 

 

DATE (YYYY/MM/DD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

COMPLAINANT HEARING REQUEST:

YES

 

 

NO

 

 

 

DATE (YYYY/MM/DD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

STATE HEARING REQUEST:

 

 

 

 

 

 

 

 

 

 

DATE (YYYY/MM/DD)

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.REMARKS:

NGB FORM 333, 20171128

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