Ngb Form 713 5 PDF Details

Navigating the complexities of the workplace can be challenging, especially when it involves issues of discrimination. The NGB Form 713-5 serves as a crucial tool for National Guard Technicians who find themselves in such predicaments. Rooted in the principles of fairness and equality, the form is established under the guidelines of Public Law 92-261 and related statutes, designed specifically to address formal complaints regarding discrimination. Its comprehensive approach covers discrimination based on race, color, religion, gender (including sexual harassment), national origin, age, or physical or mental handicap. An essential part of the process involves initially presenting the matter as an informal complaint to an EEO Counselor within a stipulated 45-day window from the event's occurrence. This step is vital as it aims at an early resolution before escalating to a formal complaint. The form meticulously guides complainants through documenting their grievances, emphasizing the necessity of clarity and specificity regarding the discriminatory acts encountered. Additionally, it serves multiple roles, not only facilitating the submission of a formal complaint but also assisting State Adjutant General in the thorough assessment of the case that could lead to an investigation by the National Guard Bureau. Despite the option to submit complaints in various formats, the profundity with which the NGB Form 713-5 encapsulates an individual's grievances makes it a significant document in the pursuit of justice within the National Guard's operational framework.

QuestionAnswer
Form NameNgb Form 713 5
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesngb form 23, acepted, MSPB, EEO

Form Preview Example

PAGE 1 OF 3 PAGES

FORM AL DISCRIM INATION COM PLAINT IN T HE NAT IONAL GUARD

For use of this form see NGR (AR) 6 90 -60 0/NGR (AF) 4 0 -1 6 14, the proponent is NGB-EO

NGB Case Number T-

PRIV ACY ACT STATEMENT

1 . Authority: Public Law 9 2 -2 6 1 amending 4 2 U. S.C. Section 2 0 00e

2 . Principal Purpose: Used by National Guard Technicians in filing a formal complaint of discrimination.

3 . Routine Uses: Used by National Guard Technicians in filing a formal complaint of discrimination. Used by State Adjutant General in accepting or dismissing complaints and w hen requesting investigations from the National Guard Bureau. The form becomes a part of the of ficial complaint file.

4 . Mandatory or Voluntary Disclosure and Ef fect on Individ ual not providing information. This form must be completed by a complainant in filing a formal complaint of discrimination. It is not mandatory in that complaints of discrimination w ill be acepted if submit ted in other formats. Failure to provide information as specified may result in delay or dismissal of a complaint .

INSTRUCTIONS

Any technician or applicant for technician employment w ho believes that he or she has been discriminated against because of race, color, religion, gender(including sexual harassment), national origin, age, or physical or mental handicap, in an employment mat ter subject to the control of the State National Guard or the National Guard Bureau, may file an individual complaint of discrimination. Before a formal complaint can be filed, the complainant must first present the mat ter as an informal complaint to an EEO Counselor or the SEEM w ithin 45 calendar days from the date of the alleged discriminatory event or the personnel action took place. Each issue must state a specific incident, to include dates , so that its scope is clear. Also each issue must have been discussed w ith an EEO Counselor. The Counselor

w ill assist you in statin g acceptable issues in clear terms. Any issues that are not clear and specific w ill be returned for clarification or may be dismissed.

TO BE COM PLETED BY SEEM

THE MATTERS GIVING RISE TO THE COM PLAINT W ILL BE CODED USING ONE OR M ORE OF THE FOLLOWING CODES:

 

CATEGORY

 

CODE

 

 

CATEGORY

 

 

CODE

 

CATEGORY

CODE

 

Appointment/Hire

 

(1)

Duty Ho urs

 

 

 

 

 

 

(1 0)

Reassignment

 

 

Assingment of Duties

 

(2)

Equal Pay Act Violation

 

 

 

 

 

 

(1 1)

Request Denied

(1 8)

 

Aw ards

 

(3)

Examinatio n/Test

 

 

 

 

 

 

(1 2)

Directed

(1 9)

 

Conversion to Full-Time

 

(4)

Evaluation/Appraisal

 

 

 

 

 

 

(1 3)

Reinstatement

(2 0)

 

Disciplinary Action:

 

 

Harassment

 

 

 

 

 

 

 

Retirement

(2 1)

 

Demotion

 

(5)

Non-Sexual

 

 

 

 

 

 

(1 4)

Time and At tendance

(2 2)

 

Reprimand

 

(6)

Sexual

 

 

 

 

 

 

(1 5)

Training/Education

(2 3)

 

Suspension

 

(7)

Pay Including Overtime

 

 

 

 

 

 

(1 6)

Terms/Conditios of Employment

(2 4)

 

Termination

 

(8)

Promotion/Non-Selection

 

 

(1 7)

Other

(2 5)

 

Other

 

(9)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ENTER CODE(S) FOR MATTER(S)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GIVING RISE TO THE COMMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE COUNSELOR CONTACTED

 

DATE OF INITIAL INTERVIEW

 

 

 

DATE FINAL INTERVIEW

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE FILED WITH SEEM:

 

BASED ON:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

POSTMARK

 

 

 

DELIVERY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FAXED

 

 

 

 

 

 

NO LEGIBLE POSTMARK (Use 5 days before receipt)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

NAME OF COMPLAINANT (Last Name, First Name, Mid dle)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

HOME ADDRESS (In clud ing Zip Co de)

 

 

 

 

 

 

 

3 . TELEPHONE NUMBERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. BUSINESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COM M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. HOME:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

ACTIVITY OR UNIT IN WHICH DISCRIMINATION TOOK PLACE:

 

5 . ARE YOU PRESENTLY A: (CHECK ONE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Technician

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Applicant for Employment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Former Technician

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6.

LOCATION OF THE POSITION (If dif ferent from 4 . above)

 

 

 

 

 

 

 

 

 

 

 

 

NGB FORM 7 1 3 -5, JU NE 2 0 0 1 (EF)(A DOBE V. 4 .0)

PREVIOUS EDITIONS ARE OBSOLETE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAGE 2 OF 3 PAGES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

 

CHECK BELOW THE BASES (Reasons) FOR ALLEGED DISCRIMINATION:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

R

RACE (Check Your Race)

 

 

 

Black

 

 

WHIT

 

American Indian/Alaskan Native

 

 

Asian/Pacific Islander

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A

AGE (State Your Age)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G

GENDER(Not Sexual Harassment) (Check Your

 

 

Male

 

 

Female

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gender)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S

GENDER(Sexual Harassment) (Check Your Gender)

 

Male

 

 

Female

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N

NATIONAL ORIGIN (State Your Natio nal Origin)

 

 

Hispanic

 

 

Other (Specif y)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C

COLOR (State Your Color)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H

HANDICAP (State Your Handicap)

 

 

Mental

 

 

Physical

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L

RELIGION (State Your Religion)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

O

RETALIATION (Based Upon EO/EEO Activity)

 

 

Yes

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

 

ARE YOU BEING REPRESENTED?

 

 

 

 

 

 

 

 

9 . IF YES, NAME OF REPRESENTATIVE

 

 

 

 

 

 

 

Yes (Complete 9)

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

At torney at Law

 

 

Yes

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10 .

I

 

 

 

have

 

have n ot filed a greivance on this mat ter.

 

1 1. I

 

 

 

have

 

 

 

have not appealed to MSPB.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

13 . SPECIFIC ALLEGATION AND ISSUES (Explain how you b elieve y ou w ere discrimi nated against)

Issues: A. Number each issue

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

C. Optional: You may in dicate the name of the individual you believe discriminated against you.

SAMPLE: I w as discriminated against on (date) on the basis of (Race, Religion, or other bases) w hen (briefly list the discriminatory event(s) or personnel action).

.

NGB FORM 7 1 3-5 , JUNE 2 0 01

PAGE 3 OF 3 PAGES

13 . SPECIFIC ALLEGATION AND ISSUES (Cont inu ed)

14 . SIGNATURE OF COMPLAINANT

15 . DATE

Do not date before you receive a Notice of Final Interveiw and Right to File a Complaint from your EEO Counselor

NGB FORM 7 1 3-5 , JUNE 2 0 01

How to Edit Ngb Form 713 5 Online for Free

You'll be able to prepare 2001 easily in our online tool for PDF editing. The tool is consistently maintained by us, receiving awesome functions and growing to be greater. To start your journey, go through these simple steps:

Step 1: Open the PDF file inside our tool by hitting the "Get Form Button" above on this page.

Step 2: The editor helps you customize almost all PDF files in a variety of ways. Transform it with customized text, adjust original content, and put in a signature - all when it's needed!

If you want to fill out this document, ensure you type in the required details in each blank field:

1. Complete the 2001 with a number of essential blank fields. Get all the necessary information and ensure there is nothing left out!

Stage # 1 for completing 2000e

2. Soon after the prior selection of blank fields is done, go to enter the applicable information in all these: CHECK BELOW THE BASES Reasons FOR, RACE Check Your Race, Black, Whit, American IndianAlaskan Native, AsianPacific Islander, A AGE State Your Age, GENDERNot Sexual Harassment Check, Male, Female, GENDERSexual Harassment Check Your, Male, Female, NATIONAL ORIGIN State Your, and Hispanic.

A way to fill in 2000e part 2

3. Completing SAMPLE events or personnel action, I w as discriminated against on, and NGB FORM JUNE is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Guidelines on how to fill in 2000e part 3

In terms of I w as discriminated against on and NGB FORM JUNE, make sure that you don't make any mistakes here. Those two are surely the key fields in this form.

4. This next section requires some additional information. Ensure you complete all the necessary fields - SPECIFIC ALLEGATION AND ISSUES, and PAGE OF PAGES - to proceed further in your process!

Best ways to complete 2000e stage 4

5. This final stage to finalize this form is integral. You'll want to fill out the required fields, which includes SIGNATURE OF COMPLAINANT, DATE, NGB FORM JUNE, and Do not date before you receive a, prior to finalizing. Otherwise, it might generate an unfinished and potentially invalid document!

2000e writing process outlined (portion 5)

Step 3: Revise the information you've entered into the form fields and then hit the "Done" button. Download the 2001 as soon as you sign up for a 7-day free trial. Easily access the pdf form within your FormsPal account, together with any edits and changes all saved! FormsPal is focused on the confidentiality of our users; we make sure that all personal information coming through our tool stays confidential.

Ngb Form 713 5 isn’t the one you’re looking for?

Related Documents