***FOR USE IN EEO RELATED CASES NOT ALLEGING AGE DISCRIMINATION***

**Mediation Agreement (EEO w/o Age)**

This agreement is entered into between (name of employee), hereinafter
referred to as the "Aggrieved Person or Complainant," and the Department
of Veterans Affairs, (specify the administration or staff office),
hereinafter referred to as the "Agency."

1\. In return for, and in consideration of the actions of the Agency set
forth in paragraph

2 below, the Aggrieved Person/Complainant hereby:

a\. By execution of this agreement, Aggrieved Person/Complainant
voluntarily withdraws all pending informal and formal EEO complaints,
including but not limited to EEO Case No. \_\_\_\_\_\_\_\_\_\_.

b\. Waives any and all actions, claims, complaints, EEO complaints,
grievances, appeals and proceedings of whatever nature against the
Agency, its past and present officers and employees, in their personal
as well as their official capacities, including attorney fees, which are
now or hereafter may be asserted by him/her or on his/her behalf based
on any action taken as of the date of Aggrieved Person/Complaint's
execution of this agreement, with the exception of any claims that may
arise by reason of breach of any term of this mediation agreement.

c\. The Aggrieved Person/Complainant further agrees that the Agency may
submit the agreement as evidence of withdrawal or waiver of any claim to
be withdrawn or waived hereunder.

d\. The Aggrieved Person/Complainant also agrees to promptly provide any
documents or take other action necessary to effectuate the withdrawal,
dismissal, or waiver of any claim in compliance with this agreement, or
to determine the amount payable by the Agency under this agreement.

2\. The Agency shall:

(Specify, in detail, whatever terms have been agreed upon)

\[If monetary relief is part of this agreement, add....Any tax liability
arising from this payment to the Aggrieved Person/Complainant is the
sole responsibility of the Aggrieved Person/Complainant. The Agency
makes no representation as to the taxability of this payment or as to
the tax treatment this payment will receive from the Internal Revenue
Service.\]

3\. The parties specifically acknowledge the Aggrieved
Person/Complainant has preserved the following rights and
responsibilities through the execution of this agreement:

a\. The Aggrieved Person/Complainant has thoroughly reviewed the entire
agreement and understands it provisions.

b\. The Aggrieved Person/Complainant has not waived any rights or claims
that may arise after the date this agreement is signed.

c\. The Aggrieved Person/Complainant is advised of her/his right to
consult with an attorney prior to signing the agreement.

4\. Both parties also agree that:

a\. This agreement does not constitute an admission of guilt or
liability on the part of either party and is entered into solely for the
purpose of resolving the stated matters in a manner mutually
satisfactory to both parties.

b\. This agreement constitutes the entire understanding between the
parties. There are no other terms or commitments; either oral or
written, to this agreement except those specified herein.

c\. This agreement shall not serve as a precedent for resolving any
other complaints, which have been or may be filed by the Aggrieved
Person/Complainant or any other person.

d\. The Aggrieved Person/Complainant acknowledges that if s/he believes
the Agency has not complied with the terms of this Mediation Agreement,
s/he may notify the Deputy Assistant Secretary for Resolution
Management, in writing, within 30 days of the alleged violation and
request the terms of this Mediation Agreement be specifically
implemented. Alternatively, s/he may request that the EEO complaint be
reinstated for further processing from the point processing ceased.
Thereafter, the Aggrieved Person/Complainant may appeal to the Equal
Employment Opportunity Commission pursuant to 29 Code of Federal
Regulations, Section 1614.504 if s/he believes that the Agency has
either not fully implemented this Mediation Agreement or improperly
failed to reinstate the complaint. The Equal Employment Opportunity
Commission states that allegations of subsequent acts of discrimination
shall be processed as separate complaints under §1614.106 or § 1614.204.
If the Aggrieved Person/Complainant believes that s/he has experienced
reprisal since signing the Mediation Agreement, s/he should bring the
matter to the attention of an EEO Counselor immediately.

e\. The parties enter into this Mediation Agreement freely and
voluntarily with no unwarranted duress or undue influence from any
person or source.

The agreement shall become effective the date of the last signature to
the agreement.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Aggrieved Person/Complainant Date

Name of Management Official Date