IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO Civil Action No. (To be supplied by the court) , Plaintiff, v. , Defendant. TITLE VII COMPLAINT PARTIES 1. Plaintiff is a citizen of who presently resides at the following address: 2. Defendant lives at or is located at the following address: Attach a separate page, if necessary, to list additional parties. JURISDICTION 3. Jurisdiction is asserted pursuant to Title VII of the Civil Rights Act of 1964, 42 U.S.C. § 2000e-5. 4. Defendant is an employer within the meaning of Title VII. 5. The alleged unlawful employment practices took place at the following location: 6. Jurisdiction also is asserted pursuant to the following statutory authority: (Rev. 07/06) ADMINISTRATIVE PROCEDURES 7. Plaintiff filed a charge of discrimination with the Equal Employment Opportunity Commission or other appropriate administrative agency on (date) regarding the alleged discriminatory conduct by Defendant(s). 8. Plaintiff received from the Equal Employment Opportunity Commission or other appropriate administrative agency a Notice of Right to Sue the Defendant(s) on ________________ (date). (Please attach to the complaint a copy of the Notice of Right to Sue.) NATURE OF THE CASE 9. Defendant has discriminated against Plaintiff because of the following: (please check all that apply) Race Color Religion Sex National Origin Other (please specify) 10. Defendant has discriminated against Plaintiff because of the following: (please check all that apply) Failure to hire Failure to promote Demotion/discharge from employment Other (please specify) (Rev. 07/06) 2 FIRST CLAIM FOR RELIEF AND SUPPORTING FACTUAL ALLEGATIONS (Please number your paragraphs and attach any necessary additional pages. Alternatively, you may attach to the complaint a copy of the charge of discrimination you submitted to the Equal Employment Opportunity Commission.) (Rev. 07/06) 3 SECOND CLAIM FOR RELIEF AND SUPPORTING FACTUAL ALLEGATIONS (Please number your paragraphs and attach any necessary additional pages.) (Rev. 07/06) 4 THIRD CLAIM FOR RELIEF AND SUPPORTING FACTUAL ALLEGATIONS (Please number your paragraphs and attach any necessary additional pages.) (Rev. 07/06) 5 REQUEST FOR RELIEF Plaintiff requests the following relief: Date: (Plaintiff’s Original Signature) (Street Address) (City, State, ZIP) (Telephone Number) (Rev. 07/06) 6 WHERE TO GET HELP American Civil Liberties Union 303/777-5482 American Legion (veterans only) 303/914-5585 303/914-5586 303/914-5587 Catholic Immigration Services (immigration and deportation only) 303/742-0828 Colorado and Denver Bar associations 303/860-1112 303/860-1115 Colorado Bar Association website www.cobar.org Colorado Legal Services (formerly Legal Aid Society) Denver Fort Collins Colorado Springs 303/837-1313 970/493-2891 719/471-0380 Denver Bar Association Low Fee Match Program 303/824-5344 The Legal Center (physically challenged only) 303/722-0300 Law Line 9 (legal advice only Wednesdays 4:15-6:30 p.m.) 303/698-0999 Metropolitan Lawyer Referral Service 303/831-8000 Metro Volunteer Lawyers 303/830-8210 (Rev. 07/06) Maps: How to Find Us To obtain these forms, contact the office of the Clerk of the Court: Alfred A. Arraj United States Courthouse 901 19th Street, Room A105 Denver, CO 80294-3589 303/844-3433 (Rev. 07/06) PLAINTIFF’S CHECKLIST _____ 1 original Civil Cover Sheet _____ 1 original and 2 copies of Motion and Affidavit for Leave to Proceed Pursuant to 28 U.S.C. § 1915, if the plaintiff seeks to proceed without payment of the filing fee. Each plaintiff must complete this form if there is more than one plaintiff. _____ A check, cash, or credit card for payment of the $350.00 filing fee, if the plaintiff does not seek to proceed without payment of the filing fee. Complaint 1 original and 2 copies for court use 1 copy for the plaintiff’s records 1 copy for each defendant (3 copies for each defendant if the plaintiff is suing a federal agency) _____ 1 Notice of Lawsuit and Request for Waiver and Service of Summons for each defendant (if the defendant is a nongovernmental individual or corporation) _____ 2 copies of Waiver of Service of Summons for each defendant _____ 2 original Summons in a Civil Action for each defendant _____ 1 Form USM 285/United States Marshals Service Process Receipt and Return for each defendant, if the plaintiff asks for the United States Marshal Service to serve the complaint (Rev. 07/06) Local Rules of Practice of the United States District Court for the District of Colorado. To download this document visit our website. www.cod.uscourts.gov (Rev. 07/06) Form USM-285/United States Marshals Service Process Receipt and Return To obtain these forms, contact the office of the Clerk of the Court: Alfred A. Arraj United States Courthouse 901 19th Street, Room A105 Denver, CO 80294-3589 303/844-3433 (Rev. 07/06)