Free Statement - District Court of Arizona - Arizona

, EXHIBIT 2I
_ Case 2:03—cv—02300—ROS Document 93-30 Filed 05/30/2006 Page10f3

or vm. S I 1 A S r I
;’ <= ~ g DEPARTMENT OF VETERANS AFFAES
Q? §= OFFICE OF RESOLUTION MANAGEMENT .
` ·= ; __ _ Los Angeles, CA
*77: 53. QQ ' i V · `
EI: INITIAL CONTACT/INTERVIEW SHEET I
Case Number 200P-0644—2001100409 · s Counselor: Lynne Woods—Hurd
NAME, ADDRESS/TELEPHONE NUMBER Martha Elizabeth SIaughter—Payne A I
OF AGGRI-EVED PARTY . 15849 West Durango Street ·
I I I . Goodyear, AZ 58338 i
_ . _ I 623-93249437 _ I * V
BUSINESS ADDRESS AND TELEPHONE 650 East Indian School Road
NUMBER ` Phoenix, AZ 85012 o `
EMPLOYEE, FORMER EMPLOYEE OR Current Employee
APPLICANT I I _ .
POSITION TITLE AND SERIESIGRADE Unclassified Duties, GS—9
Title 5, Title sa on Hybrid Tse Title 5
TYPE OF APPOINTMENT: Probationary, CNGQV
Career; Career-Cond; Temp; or Term FUH·T'm€ A
WOFIKSCHEDULE: FT or PT
ORGANIZATIONAL SERVICEISECTIONI Mental Health/Behavioral Sciences ~
DIVISION AND TELEPHONE # _ 602-277-5551, Ext. 7334 .
= y _ Carl T. Hayden VA Medical Center
NAME AND ADDRESS OF RESPONSIBLE 650 East Indian School Road
FACILITY I Phoenix, AZ 85012
Date/Initial Contact: 10/31/01 I Date/Initial Interview: 10/31/01 A I
Date/Ri hts & Res on. Rec’d: 11/03/01 Date/Final Interview: 11/23/01
Date/Notice of Ri ht to File: 11/23/01 Date/Ri ht to File Rec’d: 11/29/01 .
BASIS(E CLAIM(S) s DATE 1 RESOLUTION(S) “
l
Reprisal Hostile Working Conditions Termination of P. West, R.
Offered VSIP 9/20/01 Martinez, R. Pasquale.
Received lower graded job offer 9/26/01 Reassignment to Computer
Notified of intention to RIF 10/17/01 Specialist, GS-9/11
Assigned to unclassified duties 10/26/01 End all harassment and
` NTE: 1 month ` intimidation
ww rt
Did Aggrieved Party choose to remain anonymous? [ ] Yes [ ] No
Was there an agreement to participate in ADR? [ ] Yes [ ] No ·
Was ADR/Mediation explained to Aggrieved Party [ ] Yes [ ] No
Case 2:03-cv-02300-ROS Document eseso Filed 05/30/2006 Page 2ei sEXlI"BlT 21

_ LOS ANGELES ORM INITIAL INTERVIEW SHEET (Continued) ( _
AGGRIEVED: Slaughter-Payne, Martha Elizabeth DATE OFINITIAL INTERVIEW: 10/31/01 -
TYPE OF CONTACT: Phone I I
WAS CONTACT MADE WITH ANOTHER EEO OFFICIAL? IF YES, WHO? NO ~ . _ ·
HAVE YOU FILED PREVIOUS EEO CLAIMS?: YES l r g E V ,
WAS AN MSPB APPEAL FILED ON ANY OF THESE CLAIM (S)? IF YES, WHEN? NO A
HAS A GRIEVANCE BEEN FILED ON ANY OF THESE CLAIMS (S)? IF YES, WHEN? NO ,
WHAT SPECIFIC IN-CIDENT(S) OCCURRED WITHIN THE PAST 45 DAYS. (IF ANY DATE IS MORE V
THAN 45 DAYS BEFORE THIS INITIAL CONTACT, EXPLAIN THE DELAY. GATHER EVIDENCE TO
DETERMINE ACCEPTANCE (SEE EEO COUNSELOR MANUAL FOR EVIDENCE TO GATHER).
CLAIM(s): Working Conditions (Hostile Environment) ` . `
DATE (S) OF OCCURRENCE: September 20, 2001, September 26, 2001, October 17, 2001, October
t 26, 2001 *
WHAT IS THE BASIS FOR THIS COMPLAINT? ' A
Race (Specify White, Black, Asian/Pacific Islander, American Indian,
Alaskan Native, etc . _
—
Fieli ierl e eei I —
I Sex e eeif mele/femele _
National Ori in s ecif His anic, Jewish Israeli
A e ive date ef birth _
Disabili s ecific information about our disabili
Re risal state nature of the rior EEO activi in which ou en a ed X
Sexual Orlenterien —
WHO IS THE RESPONDING MANAGEMENT OFFICIAL? (GIVE NAME, TITLE AND TELEPHONE NUMBER)
Rafael Martinez, Personnel Officer 602-277-5551, Ext. 6432
Laurel Van Halderen, Administrator, Mental Health & Behavioral Sciences 602-277-5551, Ext. 6220
WHAT REMEDY ARE YOU SEEKING? Removal of P. West,'R. Martinez, R. Pasquale; Reassignment to
Computer Specialist, GS-9/1 1 , and.end all current and future harassment and intimidation.
HOW HAVE YOU BEEN HARMED? [WHAT ALLEGED ADVERSE EMPLOYMENT RELATED MATTER (S)
A OCCURRED?] The aggrieved believes she was subjected to hostile environment when her position was abolished
and she was offered-a Voluntary Separation Incentive Payment·(VSlP). Upon declination of the VSIP the aggrieved
was offered a lower graded position under the supervision of her former supervisor how was the subject of previous
EEO complaints. She subsequently became aware that the. union was informed that she would be RlF’d because of
her declination of the positionoffer. The aggrieved believes that she is being subjected to a hostile environment in
an effort to intimidate and coerce her because of her previous EEO complaints and her active role inthe local union. ·
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