The PS 2565 F form serves as a critical document within the U.S. Postal Service, facilitating the resolution of Equal Employment Opportunity (EEO) complaints, including those filed under the Age Discrimination in Employment Act of 1967 (ADEA). It is designed to document the settlement agreements reached between the Postal Service and employees or applicants who have raised discrimination claims. Key aspects of the form cover the voluntary agreement of the complainant to withdraw their EEO claims in exchange for consideration from the Postal Service, an acknowledgment of the complainant's rights under ADEA, and stipulations to ensure that the settlement was reached voluntarily without any form of harassment, threats, coercion, or intimidation. Additionally, the form outlines the process for the complainant to notify the Postal Service of any alleged noncompliance with the terms of the agreement and the possible repercussions. It also includes a Privacy Act Notice explaining the collection, use, and potential disclosure of the information provided on the form. The establishment of such a document underscores the importance of a systematic approach to resolving discrimination complaints, ensuring both parties' interests are considered and protecting the rights of employees or applicants facing discrimination, thereby reinforcing a commitment to equity and fairness within the workplace.
| Question | Answer |
|---|---|
| Form Name | Ps Form 2565 F |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | ADEA, stipluations, fillable ps 2565, ps form 2564 a |
U.S. Postal Service
EEO Settlement Agreement (Including Claims Filed Under ADEA)
Complaint Case No.
Date Filed
Section 1. Stipulations
1.I, ___________________________________________________________, do hereby voluntarily agree to withdraw the following claims in my EEO Complaint, which included claims under the Age Discrimination in Employment Act of 1967 (ADEA):
2. My withdrawal is based on the following stipulations:
Additionally, I acknowledge that I have been advised of my rights under the Age Discrimination in Employment Act of 1967, as amended, and that I understand and agree that:
(1)This settlement agreement does not waive any ADEA rights or claims that may arise after the date on which I sign this agreement.
(2)I have received consideration (something which has value to me to which I am not already entitled) from the Postal Service in exchange for signing this agreement.
(3)I had adequate time to consider my decision to agree to settle this EEO Complaint.
(4)I have been advised in writing of my right to seek the advice of an attorney prior to signing this agreement.
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 that the Postal Service has failed to adhere to the stipulations contained in this agreement for any reason not attributed to my acts or conduct, I must notify the Manager, EEO Compliance and Appeals, located in my area, in writing, of the alleged noncompliance within 30 calendar days of the alleged noncompliance. (Employees at Postal Service Headquarters or 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 are to be specifically implemented or, alternatively, that the 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.
PS Form
Section 2. Acknowledgement of Receipt of Settlement Offer
I am signing my name to acknowledge that I received a copy of this settlement offer on _____________________.
My signature in Section 2 does not mean that I agree to the stipulations listed in Section 1.
Signature of Complainant
Date
Signature of EEO Complaints Investigator
Date
Section 3. Acceptance of Settlement Offer
I am signing my name in Section 3 to acknowledge that I have had adequate time to consider my decision and I voluntarily agree to withdraw my EEO complaint based on the stipluations listed in Section 1. I fully understand that by agreeing to this settlement, I waive my rights to any further appeal of my complaint through the EEO process. I further stipulate that this agreement did not result from harassment, threats, coercion or intimidation.
Signature of Complainant
Date
Section 4. Signature of Management Representative
Management agrees to the aforementioned stipulations 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
Complaints Investigator: If PS Form
PS Form