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Employment Discrimination Complaint Form. This is a Indiana form and can be use in District Court Federal.
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Tags: Employment Discrimination Complaint, Indiana Federal, District Court
UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF INDIANA
_____________________________, )
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Plaintiff,
vs.
Cause No.
_____________________________, )
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Defendant.
EMPLOYMENT DISCRIMINATION COMPLAINT
Plaintiff brings a complaint against defendant ______________________ for
discrimination as set forth below.
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;
_______ The Age Discrimination in Employment Act (29 U.S.C. § 621), and
jurisdiction is based on 28 U.S.C. § 1331;
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_______ The Americans with Disabilities Act (42 U.S.C. § 12101), and jurisdiction is
based on 28 U.S.C. § 1331;
_______ The Rehabilitation Act (29 U.S.C. § 701, et seq.), and jurisdiction is based on
28 U.S.C. § 1331;
_______ Equal rights under law (42 U.S.C. § 1981), and jurisdiction is based on
28 U.S.C. § 1331;
_______ Other (list):
2.
Plaintiff ____ DID ____ DID NOT (indicate which) timely file a charge of
discrimination with the Equal Employment Opportunity Commission or the Indiana Civil Rights
Commission. [Attach a copy of charge to this complaint].
3.
Plaintiff's Right to Sue Notice from the Equal Employment Opportunity Commission or
the Indiana Civil Rights Commission was received on or about ______________________
(insert date). [Attach a copy of Notice of Right to Sue to this complaint].
III. STATEMENT OF LEGAL CLAIM
Plaintiff is entitled to relief in this action because:
IV. FACTS IN SUPPORT OF COMPLAINT
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V. PRAYER FOR RELIEF
Based on the foregoing, plaintiff seeks the following relief:
(Use additional sheets if necessary.)
VI. SIGNATURE
Signed this _______ day of _____________________, 20 __.
__________________________________
(Signature of Plaintiff)
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