Nebraska > Federal > Bankruptcy Court > Employment Dispute Resolution Plan
Request For Mediation Under EEO-EDR Plan - Nebraska
| Request For Mediation 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 MEDIATION 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. Please attach a copy of the REQUEST FOR COUNSELING FORM filed in connection with this matter. 1. Full Name of Person Requesting Mediation 2. If any of the information supplied in the REQUEST FOR COUNSELING FORM filed in connection with this matter is no longer accurate, please note the number of the entry on the request for counseling form to be changed, and state the change(s) you wish to make: 3. Date counseling was initiated 4. Date of receipt of the notice of conclusion of counseling 5. Name of person who provided counseling This request for mediation is submitted by: Signature DateName of Person to whom submitted: Signature of Recipient Date of Receipt:
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