Reply-To: "Lee Kent"
From: "Lee Kent"
To:
Subject: my form 5 completed (I found a template online!)
Date: Fri, 30 Aug 2002 13:38:34 -0400
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CHARGE OF DISCRIMINATION
AGENCY
CHARGE NUMBER
=20
This form is affected by the Privacy Act of 1974; See =
Privacy Act Statement before completing this form.
[ ] FEPA

[X] EEOC
=20
=20

=20


=20

=20

=20


=20

and EEOC
=20


State or local Agency, if any
=20

=20
NAME(Indicate Mr., Ms., Mrs.)=20

Lee Kent Hempfling
HOME TELEPHONE (Include Area Code)=20

843-327-1996
=20


=20

=20
STREET ADDRESS CITY, STATE AND ZIP CODE=20

53 Muirfield Parkway, Charleston S.C. 29414
DATE OF BIRTH=20

09/09/52
=20


=20

=20
NAMED IS THE EMPLOYER, LABOR ORGANIZATION, EMPLOYMENT =
AGENCY, APPRENTICESHIP COMMITTEE, STATE OR LOCAL GOVERNMENT AGENCY WHO =
DISCRIMINATED AGAINST ME (If more than one list below.)
=20
NAME
NUMBER OF EMPLOYEES, MEMBERS
TELEPHONE (Include Area Code)
=20
L.M. Communications Inc.=20
15+

843-769-4799

=20
STREET ADDRESS CITY, STATE AND ZIP CODE
COUNTY
=20
59 Windemere Parkway, Charleston S.C. 29407
Charleston

=20
NAME
TELEPHONE NUMBER (Include Area Code)
=20


=20

=20
STREET ADDRESS CITY, STATE AND ZIP CODE
COUNTY
=20


=20

=20
CAUSE OF DISCRIMINATION BASED ON (Check appropriate box(es))

[ ] RACE=20
[ ] COLOR=20
[ ] SEX=20
[ X ] RELIGION=20
[ ] AGE=20
=20

[ X ] RETALIATION=20
[ ] NATIONAL ORIGIN [ ] DISABILITY=20
[ ] OTHER (Specify)=20
=20
DATE DISCRIMINATION TOOK PLACE EARLIEST (ADEA/EPA) LATEST =
(ALL)=20

07/24/2002=20
=20
[ ] CONTINUING ACTION
=20
=20

=20
=20
=20
THE PARTICULARS ARE (If additional paper is needed, attach =
extra sheet(s)):
=20

I. My date of birth is 9/9/1952 and I am currently 49 years =
of age. I was hired by L.M. Communications Inc., [inc.] on 1/25/2002 and =
started work on 2/4/2002. I was was told I was discharged for "poor =
performance of the station" on 7/23/2002.=20


II. I was subjected to discriminatory terms and conditions =
of employment, harassed, denied employment, subjected to a hostile =
religious and retaliatory work environment and discharged from my full =
time position because of retaliation for my attempt to offer equal =
employment ability in hiring of minorities, (cont.)=20
=20
I want this charge filed with both the EEOC and the =
State or local Agency, if any. I will advise the agencies if I change my =
address or telephone number and I will cooperate fully with them in the =
processing of my charge in accordance with their procedures.
=20
NOTARY - (When necessary for State and Local Requirements)

I swear or affirm that I have read the above charge =
and that it is true to the best of my knowledge, information and belief.
=20
=20
I declare under penalty of perjury that the foregoing is =
true and correct.
SIGNATURE OF COMPLAINANT
=20


=20

=20


SUBSCRIBED AND SWORN TO BEFORE ME THIS DATE

(Day, month, and year)
=20
Date
=20

Charging Party (Signature)
=20

=20
EEOC FORM 5 (Test 10/94)
=20
=20



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>



















size=3D4>CHARGE OF =
DISCRIMINATION


style=3D"FONT-SIZE: 9pt" =
size=3D2>AGENCY


style=3D"FONT-SIZE: 9pt" size=3D2>CHARGE =
NUMBER


border=3D0>





face=3Dverdana,arial,helvetica> size=3D1>This form is affected by the Privacy Act of =
1974; See=20
Privacy Act Statement before completing this=20
form.

  

style=3D"FONT-SIZE: 9pt" size=3D2>[ ] =
FEPA


style=3D"FONT-SIZE: 9pt" size=3D2>[X]=20
EEOC













style=3D"FONT-SIZE: 8pt"=20
size=3D1>and EEOC


size=3D1>State or local Agency, if =
any



style=3D"FONT-SIZE: 8pt"=20
size=3D1>NAME(Indicate Mr., Ms., Mrs.)=20

Lee Kent Hempfling

style=3D"FONT-SIZE: 8pt"=20
size=3D1>HOME TELEPHONE (Include Area Code)=20

843-327-1996



style=3D"FONT-SIZE: 8pt"=20
size=3D1>STREET ADDRESS CITY, STATE AND ZIP CODE=20

53 Muirfield Parkway, Charleston S.C. =
29414

style=3D"FONT-SIZE: 8pt"=20
size=3D1>DATE OF BIRTH=20

09/09/52



face=3Dverdana,arial,helvetica>NAMED IS THE EMPLOYER, LABOR=20
ORGANIZATION, EMPLOYMENT AGENCY, APPRENTICESHIP COMMITTEE, =
STATE OR=20
LOCAL GOVERNMENT AGENCY WHO DISCRIMINATED AGAINST ME=20
size=3D2> face=3DArial>(If more than one list=20
below.)

style=3D"FONT-SIZE: 8pt"=20
size=3D1>NAME

style=3D"FONT-SIZE: 8pt"=20
size=3D1>NUMBER OF EMPLOYEES, MEMBERS

style=3D"FONT-SIZE: 8pt"=20
size=3D1>TELEPHONE (Include Area =
Code)


size=3D2>L.M.=20
Communications Inc.


15+

843-769-4799

style=3D"FONT-SIZE: 8pt"=20
size=3D1>STREET ADDRESS CITY, STATE AND ZIP =
CODE

style=3D"FONT-SIZE: 8pt"=20
size=3D1>COUNTY


59 =
Windemere=20
Parkway, Charleston S.C. 29407

Charleston

style=3D"FONT-SIZE: 8pt"=20
size=3D1>NAME

style=3D"FONT-SIZE: 8pt"=20
size=3D1>TELEPHONE NUMBER (Include Area=20
Code)



style=3D"FONT-SIZE: 8pt"=20
size=3D1>STREET ADDRESS CITY, STATE AND ZIP =
CODE

style=3D"FONT-SIZE: 8pt"=20
size=3D1>COUNTY



style=3D"FONT-SIZE: 8pt"=20
size=3D1>CAUSE OF DISCRIMINATION BASED ON (Check =
appropriate=20
box(es))









face=3Dverdana,arial,helvetica> style=3D"FONT-SIZE: 8pt" size=3D1>[ ] =
RACE=20

face=3Dverdana,arial,helvetica> style=3D"FONT-SIZE: 8pt" size=3D1>[ ] =
COLOR=20

face=3Dverdana,arial,helvetica> style=3D"FONT-SIZE: 8pt" size=3D1>[ ] =
SEX=20

face=3Dverdana,arial,helvetica> style=3D"FONT-SIZE: 8pt" size=3D1>[ X ] =
RELIGION=20

face=3Dverdana,arial,helvetica> style=3D"FONT-SIZE: 8pt" size=3D1>[ ] =
AGE=20









face=3Dverdana,arial,helvetica> style=3D"FONT-SIZE: 8pt" size=3D1>[ X ] =
RETALIATION=20

face=3Dverdana,arial,helvetica> style=3D"FONT-SIZE: 8pt" size=3D1>[ ] NATIONAL=20
ORIGIN		 face=3Dverdana,arial,helvetica> style=3D"FONT-SIZE: 8pt" size=3D1>[ ] =
DISABILITY=20

face=3Dverdana,arial,helvetica> size=3D1>[ ] OTHER (Specify)=20








style=3D"FONT-SIZE: 8pt" size=3D1>DATE DISCRIMINATION =
TOOK PLACE=20
EARLIEST (ADEA/EPA) LATEST (ALL)=20

07/24/2002=20


style=3D"FONT-SIZE: 8pt" size=3D1>[ ] CONTINUING=20
=
ACTION



style=3D"FONT-SIZE: 8pt"=20
size=3D1>THE PARTICULARS ARE (If additional paper is =
needed, attach=20
extra sheet(s)):


face=3Dverdana,arial,helvetica>9pt" size=3D2>

I. My date of birth is 9/9/1952 and I am =
currently=20
49 years of age. I was hired by L.M. Communications Inc., =
[inc.] on=20
1/25/2002 and started work on 2/4/2002. I was was told I was =

discharged for "poor performance of the station" on =
7/23/2002.=20


face=3Dverdana,arial,helvetica>9pt" size=3D2>

II. I was subjected to discriminatory =
terms and=20
conditions of employment, harassed, denied employment, =
subjected to=20
a hostile religious and retaliatory work environment and =
discharged=20
from my full time position because of retaliation for my =
attempt to=20
offer equal employment ability in hiring of minorities, =
(cont.)=20







style=3D"FONT-SIZE: 8pt" size=3D1>I want this charge =
filed with=20
both the EEOC and the State or local Agency, if any. I =
will=20
advise the agencies if I change my address or =
telephone number=20
and I will cooperate fully with them in the processing =
of my=20
charge in accordance with their=20
procedures.

  

style=3D"FONT-SIZE: 8pt"=20
size=3D1>NOTARY - (When necessary for State and Local=20
Requirements)


border=3D1>



style=3D"FONT-SIZE: 8pt" size=3D1>I swear or affirm =
that I have=20
read the above charge and that it is true to the best =
of my=20
knowledge, information and=20
=
belief.

style=3D"FONT-SIZE: 8pt"=20
size=3D1>I declare under penalty of perjury that the =
foregoing is true=20
and correct.

style=3D"FONT-SIZE: 8pt"=20
size=3D1>SIGNATURE OF =
COMPLAINANT





face=3Dverdana,arial,helvetica>8pt"=20
size=3D1>SUBSCRIBED AND SWORN TO BEFORE ME THIS =
DATE


(Day, =
month, and=20
year)


size=3D1>Date



size=3D1>Charging Party=20
(Signature)



style=3D"FONT-SIZE: 8pt"=20
size=3D1>EEOC FORM 5 (Test=20
10/94)





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