Nebraska > Federal > Bankruptcy Court > Employment Dispute Resolution Plan
Request For Counseling Under EEO-EDR Plan - Nebraska
| Request For Counseling Under EEO-EDR Plan Form. This is a Nebraska form and can be used in Employment Dispute Resolution Plan Bankruptcy Court Federal . |
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REQUEST FOR COUNSELING UNDER EEO/EDR PLAN Submitted Under the Procedures of the District of Nebraska Equal Employment Opportunity and Employment Dispute Resolution Plan (District of Nebraska EEO/DER Plan) ***************************** Prior to completing this form, please refer to the District of Nebraska EEO/EDR Plan. Please complete this form legibly. 1. Full Name of Person Requesting Counseling 2. Mailing Address 3. Home Phone ( ) Work Phone ( ) 4. If you are a court employee, state the following: Court Unit in which employed Job Title 5. Name and address of the office from which you seek resolution of your dispute. 6. Date(s) of alleged incident of decision giving rise to this dispute: 7. Please summarize the actions or occurrences giving rise to this dispute . 8. Are you willing to waive confidentiality in order to permit the counselor to contact the employing office or to attempt a resolution of the disputed matter? G yes G no9. What corrective action do you seek in this matter? This request for counseling is submitted by: Signature DateName of Counselor to whom submitted: Counselors Signature Date of Receipt:
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