UNITED STATES DISTRICT COURT EASTERN DISTRICT OF ARKANSAS _______________________ DIVISION ____________________________________ ____________________________________ ____________________________________ (Name of plaintiff or plaintiffs) v. CIVIL ACTION NO.________________________ (case number to be supplied by the assignment clerk) ____________________________________ ____________________________________ ____________________________________ (Name of defendant or defendants) COMPLAINT UNDER TITLE VII OF THE CIVIL RIGHTS ACT OF 1964 1. This action is brought pursuant to Title VII of the Civil Rights Act of 1964 for employment discrimination. Jurisdiction is specifically conferred on the Court by 42 U.S.C. §2000e-5. 2. Equitable and other relief are also sought under 42 U.S.C. §2000e-5(g). Plaintiff, ____________________________________________________, is a (name of plaintiff) citizen of the United States and resides at ___________________________________________, (street address) ________________________, ___________________, _____________________, __________, (city) (county) (state) (ZIP) ________________________. (telephone) Defendant, ____________________________________________, lives at, or its (name of defendant) business is located at _____________________________________, ______________________, (street address) (city) __________________, ______________________, _________________. (county) (state) (ZIP) 4. Plaintiff sought employment from the defendant or was employed by the 3. American LegalNet, Inc. www.FormsWorkflow.com defendant at __________________________________, ________________________________, (street address) (city) _________________, _______________________, _________________. (county) (state) (ZIP) 5. Defendant discriminated against plaintiff in the manner indicated in paragraphs 9 and 10 of the complaint on or about ________________________________________________. (month) (day) (year) 6. Plaintiff filed charges against the defendant with the Equal Employment Opportunity Commission charging defendant with the acts of discrimination indicated in paragraphs 9 and 10 of this complaint on or about _____________________________________. (month) (day) (year) 7. The Equal Employment Opportunity Commission issued a Notice of Right to Sue which was received by plaintiff on _________________________________, a copy of which notice (month) (day) (year) is attached to this complaint. 8. Because of plaintiff's (1) ________ race, (2) ________ color, (3)________ sex, (4) ________ religion, (5) ________ national origin, defendant: (a) ________ failed to employ plaintiff. (b) ________ terminated plaintiff's employment. (c) ________ failed to promote plaintiff. (d) ________ ______________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 9. The circumstances under which the defendant discriminated against plaintiff were American LegalNet, Inc. www.FormsWorkflow.com as follows:_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 10. The acts set forth in paragraph 9 of this complaint: (a) ________ are still being committed by defendant. (b) ________ are no longer being committed by defendant. (c) ________ may still be being committed by defendant. 11. Plaintiff attaches to this complaint a copy of the charges filed with the Equal Employment Opportunity Commission which charges are submitted as a brief statement of the facts supporting this complaint. WHEREFORE, plaintiff prays that the Court grant the following relief to the plaintiff: (a) ________ Defendant be directed to employ plaintiff, and (b) ________ Defendant be directed to re-employ plaintiff, and (c) ________ Defendant be directed to promote plaintiff, and (d) ________ Defendant be directed to __________________________________ and that the Court grant such relief as may be appropriate, including injunctive orders, damages, costs and attorney's fees. __________________________________________ SIGNATURE OF PLAINTIFF American LegalNet, Inc. www.FormsWorkflow.com