Appendix 5




(Pre-complaint Process)

I elect Alternative Dispute Resolution (ADR) of the issues that I presented to the Equal Employment Opportunity (EEO) Counselor on (Date) .

I understand that having my issue(s) addressed through ADR process during the pre-complaint process can bring early resolution. The EEO-PLUS ADR process does not replace the current EEO complaint process. Rather, it is designed to enhance the resolution efforts.

In electing ADR, the pre-complaint processing period may continue up to ninety (90) days. The EEO Counselor will complete the intake functions of counseling (that is, obtain the information needed to determine the basis(es), claim(s), time), and provide me with the notice of rights and responsibilities before referring the dispute to the ADR process.

In order to facilitate resolution, I understand that all parties involved in the ADR process must be free to explore all options for resolution without fear of reprisal. Offers and statements made by the parties during the process cannot be used against either party if resolution fails. All discussions during the ADR process are confidential. If the issue is resolved, the terms of the resolution will be put in writing and signed by all parties.

If ADR fails, the EEO Counselor will issue the Notice of Final Interview and Right to File a Discrimination Complaint (NOFI) to me, and will prepare the Counseling Report pursuant to 1614.105(c). The report will contain relevant information about my complaint, jurisdiction, claims, bases, requested remedy, and related documents. The report will not provide a summary of the informal resolution attempt other than to indicate that I elected the ADR program and that the dispute was not resolved through this procedure.

I understand that my election of ADR is final.


Signature of Aggrieved Person Date