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Request For Counseling Under EEO-EDR Plan Form. This is a Nebraska form and can be use in Bankruptcy Court Federal.
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Tags: Request For Counseling Under EEO-EDR Plan, Nebraska Federal, Bankruptcy Court
COURT
COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . REQUEST FOR COUNSELING UNDER EEO/EDR PLAN
:
Index No.
Submitted Under the Procedures of the District of Nebraska Equal Employment
:
Calendar No.
Opportunity and Employment Dispute Resolution Plan (“District of Nebraska
EEO/DER Plan”)
:
JUDICIAL SUBPOENA
Plaintiff(s)
-against:
*****************************
Prior to completing this form, please refer to the District of: Nebraska EEO/EDR Plan.
Please complete this form legibly.
:
1.
Defendant(s)
Full Name of Person Requesting Counseling
:
......................................................
2.
3.
4.
Mailing Address
THE PEOPLE OF THE STATE OF NEW YORK
Home Phone (
)
Work Phone (
)
TO
If you are a court employee, state the following:
Court Unit in which employed
Job Title
GREETINGS:
5.
Name and address of the office from which you seek resolution of your dispute.
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
,
the Honorable
at the
Court
located at
County of
in room
, on the
day of
, 20
, at
o'clock in the
noon, and at any recessed
6. or adjourned date, to testify and of decision givinga witness in this action on the part of the
Date(s) of alleged incident give evidence as rise to this dispute:
7.
Please summarize the actions or occurrences giving rise to this dispute .
Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
result of your failure to comply.
Witness, Honorable
, one of the Justices of the
Court in
County,
day of
, 20
8.
Are you willing to waive confidentiality in order to permit the counselor to contact the employing office
or to attempt a resolution of the disputed matter?
G yes
G no
(Attorney must sign above and type name below)
9.
What corrective action do you seek in this matter?
Attorney(s) for
This request for counseling is submitted by:
Office and P.O. Address
Signature
Name of Counselor to whom submitted:
Counselor’s Signature
Date
Telephone No.:
Facsimile No.:
E-Mail Address:
Date of Receipt: Tel. No.:
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