The PS 2565 D form is a vital document within the U.S. Postal Service's arena, serving as a structured mechanism to finalize settlement agreements pertaining to formal Equal Employment Opportunity (EEO) complaints. Through this form, a complainant formally agrees to withdraw their claims under specified conditions, offering a restrained yet crucial resolution pathway between the employee and management. It emphasizes the voluntary nature of the agreement, heavily underscoring that the decision to settle should be free from any form of duress, such as harassment or coercion. Additionally, it provides a specific avenue for addressing any potential noncompliance by the Postal Service post-agreement, detailing a 30-day window for the complainant to express grievances if the terms are not honored. Notably, the form also touches upon privacy concerns, stating the various legal and organizational frameworks that may permit the disclosure of the information provided, highlighting the form's role not just in dispute resolution but also in safeguarding the participants' privacy. Overall, the PS 2565 D form encapsulates a critical process within the EEO framework of the U.S. Postal Service, balancing the need for resolution with the rights and protections afforded to employees.
| Question | Answer |
|---|---|
| Form Name | Ps Form 2565 D |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | attributable, 2001, USPS, 633a |
U.S. Postal Service
EEO Settlement Agreement — Formal Complaint
Case No.
1.I, __________________________________________, do hereby voluntarily agree to withdraw the following claims in my EEO complaint:
2. My withdrawal is based on the following stipulations:
I fully understand that by agreeing to this resolution, I waive my rights to any further appeal of my complaint through the EEO process. I further state that this agreement did not result from harassment, threats, coercion or intimidation.
I am fully aware that any settlement agreement knowingly and voluntarily agreed to by the parties, reached at any stage of the complaint process is binding on both parties. Should I believe the Postal Service has failed to adhere to the stipulations contained in this agreement for any reason not attributable to my acts or conduct, I must notify the Manager EEO Compliance and Appeals located in my area, in writing, within 30 calendar days of the alleged noncompliance. (Employees at Postal Service Headquarters and Headquarters Field Units and employees of the Inspection Service should notify the EEO Appeals Review Specialist at Postal Service Headquarters.) I may include in my statement of noncompliance a request that the terms of the settlement agreement be specifically implemented or, alternatively, that my complaint be reinstated for further processing from the point processing ceased. The Postal Service will respond to my request in accordance with 29 C.F.R. § 1614.504.
Privacy Act Notice
Privacy Act Notice. The collection of this information is authorized by the Equal Employment Opportunity Act of 1972, 42 U.S.C. §
contracts, licenses, grants or other benefits; to a congressional office at your request; to an expert, consultant, or other person under contract with the USPS to fulfill an agency function; to the Federal Records Center for storage; to the Office of Management and Budget for review of private relief legislation; to an independent certified public accountant during an official audit of USPS finances; to an investigator, administrative judge or complaints examiner appointed by the Equal Employment Opportunity Commission for investigation of a formal EEO complaint under 29 CFR 1614; to the Merit Systems Protection Board or Office of Special Counsel for proceedings or investigations involving personnel practices and other matters within their jurisdiction; and to a labor organization as required by the National Labor Relations Act. Under the Privacy Act provision, the information requested is voluntary for the complainant, and for Postal Service employees and other witnesses.
Signature of Complainant
Date
Management agrees to the aforementioned stipulation solely in an effort to resolve the complainant’s allegation(s), and this agreement should not be construed as an admission of discrimination or wrongdoing on the part of any official of the U.S. Postal Service.
Signature of Management Representative
Date
Printed Name of Management Representative
Title of Management Representative
PS Form