APPENDIX VII - Withdrawal Form.pdf
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- Solicitation number
- 1331L525R13OS0001
About this file
This is a Withdrawal Form template (Appendix VIII) used for withdrawing Equal Employment Opportunity (EEO) complaints within the Department of Commerce. The form allows complainants to voluntarily withdraw their EEO complaint by providing their name, the EEO complaint number, and the withdrawal date.
The form includes a statement confirming that the withdrawal is voluntary and not the result of threat, coercion, intimidation, promise, or inducement by any Department of Commerce employee or affiliate contract employee. It also includes an acknowledgment that by withdrawing the complaint, the complainant waives their right to raise the claims contained in their complaint in any future administrative or judicial forum. The document requires the complainant's signature to complete the withdrawal.
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Text version
Appendix VIII
WITHDRAWAL FORM
WITHDRAWAL OF EEO COMPLAINT
I, ___________________________________, voluntarily withdraw EEO Complaint Number
___________________________ on this date, __________________________. This withdrawal is voluntary and not the result of threat, coercion, intimidation, promise, or inducement by any employee of Department of Commerce or affiliate contract employee. I understand that by withdrawing my Complaint, I waive my right to raise the claims contained in my complaint in the future in any administrative or judicial forum.
Signature of Complainant
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