Fillable E L K O Y U Q T (Court Services and Offender Supervision)

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E L K O Y U Q T (Court Services and Offender Supervision)

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The E L K O Y U Q T (Court Services and Offender Supervision) form is 2 pages long and contains:

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  • 36 check-boxes
  • 27 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Court Services and Offender Supervision

BROWSE COURT SERVICES AND OFFENDER SUPERVISION (DC) FORMS

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DATE OF REQUEST:
N
AME:
Employee
Applicant
Job Title/Series/Grade:
Place of Employment:
Branch:
Supervisor:
Work Address:
Work Phone: ___________
Home Phone: ________
Email Address:
Fax No.:
N
AME OF REPRESENTATIVE (IF APPLICABLE):
Address:
Work Phone:
Home Phone:
Email Address:
D
ATE OF INITIAL CONTACT:
Office Visit
Telephone Other
D
ATE OF ALLEGED INCIDENT:
B
ASIS (ES):
Race (Black) Color (Specify) Sex (Specify)
Age (Date of Birth) Religion (Specify) National Origin (Specify)
Disability (Specify Physical or Mental) ___ Reprisal (Identify prior event)
CLAIMS/ISSUES:
Appointment/Hire Evaluation/Appraisal Reasonable Accommodation
Assignment of Duties Examination/Test Reinstatement
Awards Harassment (Non-Sexual) Retirement
Conversion to Full-Time Harassment (Sexual) Termination
Demotion Medical Examination Terms and Condition of
Employment
Reprimand Pay Including Overtime Time and Attendance
Suspension Promotion/Non-Selection Training
Removal Reassignment – Request
Denied
Reassignment – Directed
Duty Hours Other (Identify)
2
SUMMARY OF ISSUES: __________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_________________________________________________________
W
HAT CORRECTIVE ACTIONS ARE YOU SEEKING?
_____________________________________________________________________________________
____________________________________________________________________________________
DATE EEO COUNSELOR ASSIGNED: ______________
N
AME OF EEO COUNSELOR: _______________
C
OMMENTS:
FOR EEO OFFICE USE ONLY
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E L K O Y U Q T (Court Services and Offender Supervision)

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Completed 18 July 2020

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