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Complaint Under Title VII For Discrimination Form. This is a Indiana form and can be use in District Court Federal.
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Tags: Complaint Under Title VII For Discrimination, Indiana Federal, District Court
UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF INDIANA
__________________ DIVISION
_____________________________,
Plaintiff,
vs.
_____________________________,
Defendant.
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Cause No.
COMPLAINT UNDER TITLE VII FOR DISCRIMINATION
Plaintiff brings a complaint against defendant ____________________ for
violation of Title VII rights.
Plaintiff ____ DOES ____ DOES NOT (indicate which) demand a jury trial.
I. PARTIES
Plaintiff's Name, Address and
Phone Number:
Defendant's Name and Address
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
II. JURISDICTION
1.
This complaint is brought pursuant to Title VII of the Civil Rights Act of
1964, as amended, and jurisdiction is based on 42 U.S.C. §2000e-5 and 28 U.S.C. §1331.
2.
Plaintiff ____ DID ____ DID NOT (indicate which) timely file a charge of
discrimination with the Equal Employment Opportunity Commission. [Attach charge
as Exhibit 1].
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3.
Plaintiff's Right to Sue Notice from the Equal Employment Opportunity
Commission was received on or about __________________________ (insert date).
[Attach Notice of Right to Sue as Exhibit 2].
III. FACTS IN SUPPORT OF COMPLAINT
The facts on which this complaint is based are the following:
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IV. STATEMENT OF LEGAL CLAIM
Plaintiff is entitled to relief in this action because:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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V. PRAYER FOR RELIEF
Based on the foregoing, plaintiff seeks the following relief:
(Use additional sheets if necessary.)
VI. AFFIRMATION OF PLAINTIFF
I, the plaintiff in the aforementioned cause, do affirm that I have read all of the
statements contained in the complaint and that I believe them to be, to the best of my personal
knowledge, true and correct.
Signed this _______ day of _____________________, 20__.
__________________________________
(Signature of Plaintiff)
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