Free Statement - District Court of Arizona - Arizona

EXHIBIT 4
Case 2:03—cv—02300—ROS Document 93-13 Filed 05/30/2006 Page10f2

_ \_- E I _' - ,..3 I 200/-· 297
" Department of Veterans A irs COMPLAINT OF EIVIPLG'YMENT DISCRIMINATION _
1. NAME (Lan, first nu`da‘leI'nitial)(Pleo.reprir1t) _ 2. MAILING ADDRESS · ‘ aa. wommtergwe Numssn
’ ’ ` M red · -
Sl0tu5j.Ier— Payne, · [5g!-IGI \/\l·\Dt»Iv~o·n€)g Sl 0;..z7·z-*555/
ma »~I+»a E-· — -- Goody eo ri A Z 96 gg S' ` ¤=·· ¢,¤~;,,5,~3~Erg,<;5E~~~¤e
. . T I IIC ITG `
[Liz I aaa-Qaz.-t 4. ins Your ss. son rms. sssuss AND,·GRADE e. NAME Ann Anuaess or VA I=Ac¤o1·v wom oiscninruinou
. · _ A . ccunn ¤____,
MAVAEMPLDYEE · — b G • édri /. /7/CVO/(M
I] AN APPLIQNT F¤FI EMPI-¤YMENT sb. senvnce/sscraouranoou uns _
QA-Foames VA smrtovss ‘ gh U2 /9/EQ I 8
INSTRUCTIONS: For each employment related matter that you believe was discriminatory you must list the bases (list one or more of the following):
Race (Specify), Color (Specify). Religion (Sperm;). Sex {Mole or Female), Sexual Orientation, National Orlgn (Specjy), Age (.Provide_do:e of birth), _ _
Disability {SPBCQSP), and Reprisal for prior EE0 activity or having opposed discrimination. · p · .
‘ 9. DATE DF
. 8· °'·!“'M*SP . . occunnsuce
7. BASIS ( What employment related claunfsj ·- personnel acuonfs), mcrdentfsj, or eventfs), caused you to file this (hmmag the mst .
complaint? Briefly, describe what happened below. Use an awitional sheet of paper ifnecessary.] Mum. ddcfm
_ . - IJ 50*0. O
Repmselct m -
I appli d for the Computer Specialist positions that were open under the Open •. tinuos Q
anno. cement OC34, GS-0334-9/11. There were several positions vacant and s veraE e I;
1nterv1·ws done. I never received an interview for any of the positions that were illeda. 35
_. In 199 ’ I tiled and EEO complaint against Richard Moore for discriminating ag I st § 2;
becaus · of my race (African American), color (Black), and gender (Female). Jl., I5-""I
fj`} IU
rx: Z F"
’ •• Q
. .t:·· H4 ;i
IO. in edies SOl1ght · _ L`) I Q
• I •·' .`·*..' l !..` *1 'E ZC."ZC`• 'Z `Gi Su G¤r¤¢' l III -
1¤. someones sou wr . . . . . . - '
`have taken at the Ilmverstty of Phoenix. I invested a lot of time and money to better my
chances IH gettmg 1nto the computer field. I want to be place in an educational Computer
Tratmn g program w1’£h career advancement Opporumities. I Want proper actions taken
against Richard Moore for his discriminatin ; behavior. I
, 1 HL DO you 1-Inv; A ggpprgsgyqrarrvgr 1‘|h- HE OB SHE AN 11c. PHDVIDE THE NAME, ADDRESS, AND TELEPHONE NUMBER OF YOUR REPRESENTATIVE
A .
lj vas mae Ijvss lj N0 4 l l I
12a. HAVE YOU coNrAc‘rE¤ AN seo CDUNSELORP 12¤. NAME os EE0 CDUNSELDH ‘ 12¤. gralrg SSILNMAL CONTACT
[Eyes [Ina n wl. I jah KA *30*00 _
13. NOTE: If you contacted an EEO Counselor more than 4 ‘ calendar days ojter the Date{s) of Occurrence, listed in item 9, or if this complaint isjiled more than
J5 calendar days ajier recehat of a Notice of Right to File a Ditcrirnutation Complaint, you must explain why you were untimely in seeking EEO courttelbrg or
untimely in filing a complaint. (lf more space is needed, use tm additional sheet of paper. )
"°· St`LF~¥°ét5I$.%.il.¥5’»"l‘i’E§$£?"°‘ ""· I‘l}`L°éa§.él·’Il~l‘éEF€i'l‘l}“'s’ *"° ‘“°‘ §‘¢l'1§L°é’¤F§l%31i6‘~*i¤’ERtI‘{$.'l§.'*»¤”€*§~“§»’l~'l¤F Ii"I=l‘¥§»?i»%ilT&IElS?“"5’ ""°
me cows usren Asovez 4 -
[I vas E no I:] vas W no _
1s;. HAVE vou I=u.e¤ n-us conmrm wm-I iss. rr wes.- movies me sane Ann Annness _
Auvone arse:
Elves El no I l
11. SIGNATURE or CDMFLAINAHT (De new p no ‘_ »_·Ae 1 .._·-=.I. _ {_ _ _ 18- DATE -
./' / / I 1
‘ ’ ‘ / QF *0
. . if 60¢¢ . { U F
Z _ ` _ _ _ _ Oi ¤|'I'I'I
Case 2:03—cv—02300—ROS Document 93-13 Fnled 05/30/2006 Page 2 of

Case 2:03-cv-02300-ROS

Document 93-13

Filed 05/30/2006

Page 1 of 2

Case 2:03-cv-02300-ROS

Document 93-13

Filed 05/30/2006

Page 2 of 2