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Get USPS PS 2430 2001

1. Date Age Date of Birth Claim s Complainant s Representative Name Title Address of Representative Investigator s Name Print or Type Office Telephone No. Postal Address of Investigator Date Report Completed PS Form 2430 March 2001. NOTICE OF RESTRICTED USAGE Access to and usage of this EEO complaint file is RESTRICTED by both the Freedom of Information Act and the Privacy Act to 1 the complainant and his or her representative and 2 government officials who must have access to the files to discharge their OFFICIAL duties. The file and its contents must be safeguarded* Willful violations of these requirements are subject to criminal penalties 5 U*S*C. 552a i 1. EEO Investigation Report Processing Office Case No* Complainant Name Position Title Address of Complainant Name of Complainant s Supervisor Date Filed Telephone No* Email Address Preference Eligible Yes No Mixed Case Complainant s Postal Facility Responding Postal Facility Type of Complaint Race Color Religion Sex National Origin Physical Disability Mental Disability Retaliation Based on Previous EEO Activity Cited Dates and Case Nos. NOTICE OF RESTRICTED USAGE Access to and usage of this EEO complaint file is RESTRICTED by both the Freedom of Information Act and the Privacy Act to 1 the complainant and his or her representative and 2 government officials who must have access to the files to discharge their OFFICIAL duties. The file and its contents must be safeguarded* Willful violations of these requirements are subject to criminal penalties 5 U*S*C. The file and its contents must be safeguarded* Willful violations of these requirements are subject to criminal penalties 5 U*S*C. 552a i 1. EEO Investigation Report Processing Office Case No* Complainant Name Position Title Address of Complainant Name of Complainant s Supervisor Date Filed Telephone No* Email Address Preference Eligible Yes No Mixed Case Complainant s Postal Facility Responding Postal Facility Type of Complaint Race Color Religion Sex National Origin Physical Disability Mental Disability Retaliation Based on Previous EEO Activity Cited Dates and Case Nos. NOTICE OF RESTRICTED USAGE Access to and usage of this EEO complaint file is RESTRICTED by both the Freedom of Information Act and the Privacy Act to 1 the complainant and his or her representative and 2 government officials who must have access to the files to discharge their OFFICIAL duties. The file and its contents must be safeguarded* Willful violations of these requirements are subject to criminal penalties 5 U*S*C. 552a i 1. EEO Investigation Report Processing Office Case No* Complainant Name Position Title Address of Complainant Name of Complainant s Supervisor Date Filed Telephone No* Email Address Preference Eligible Yes No Mixed Case Complainant s Postal Facility Responding Postal Facility Type of Complaint Race Color Religion Sex National Origin Physical Disability Mental Disability Retaliation Based on Previous EEO Activity Cited Dates and Case Nos. .

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