Title: REQUEST FOR A HEARING FORM
Author: Chung
Last saved by: EEO21
Company: EEO 21

Appendix N EEO-MD-110

REQUEST FOR A HEARING FORM

Hearings Unit
Equal Employment Opportunity Commission
Miami District Office
2 South Biscayne Blvd., Suite 2700
Miami. FL  33131

Dear Sir/Madam:

I am requesting the appointment of an Equal Employment Opportunity Commission Administrative Judge pursuant to 29 C.F.R. § 1614.108(g).  I hereby certify that either more than 180 days have passed from the date I filed my complaint or I have received a notice from the agency that I have thirty (30) days to elect a hearing or a final agency decision.

My name &
Address:

Genise Douglas
PO Box 1367
Liberty, Missouri  64069

Agency name & address:

U.S. Depart. of Defense, Army and Air Force Exchange Service
Commander
PO Box 650077
Dallas, TX  75265-0077

Agency Case No: | AAFES 09-110; 10-012; 10-093
In accordance with section 1614.108(g), I have sent a copy of this request for a hearing to the following person at the agency:

Name:
(EEO Officer)

Director
Office of Equal Employment Opportunity

Address: 
(if different from above)

HQ AAFES-CV
PO Box 650077
Dallas, TX  75265-0077

Sincerely

						___________________________________
						Genise Douglas			Date