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Ssigned to: This form is affected by the Privacy Act of 1974; see Privacy Act Statement on Page 5 before completing this form. Please answer the following questions, telling us briefly why you believe you have been discriminated against in employment. An officer of the EEOC will review the information you provide and determine whether or not your allegations warrant a charge being filed. IF YOU HAVE ALREADY FILED WITH A STATE OR LOCAL FAIR EMPLOYMENT PRACTICES AGENCY, IT IS NOT NECESSARY TH.

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