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Civil Complaint Pursuant To Title VII Of The Civil Rights Act As Amended Form. This is a New York form and can be use in District Court Federal.
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Tags: Civil Complaint Pursuant To Title VII Of The Civil Rights Act As Amended, E(1)(b), New York Federal, District Court
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF NEW YORK
Plaintiff(s)
vs.
Defendant(s)
)
)
)
)
)
)
)
Civil Case No.:
CIVIL COMPLAINT
PURSUANT TO
TITLE VII OF THE
CIVIL RIGHTS ACT,
AS AMENDED
JURISDICTION
1.
Jurisdiction is conferred on this court pursuant to 42 U.S.C. § 2000e-5.
PARTIES
2.
Plaintiff:
Address:
Additional Plaintiffs may be added on a separate sheet of paper.
3.
a.
Defendant:
Official Position:
Address:
FORM E(1)(b).1
5/2005
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b.
Defendant:
Official Position:
Address:
4.
This action is brought pursuant to:
Title VII of the Civil Rights Act of 1964, as amended, codified at 42 U.S.C.
§ 2000e et seq., and the Civil Rights Act of 1991, for employment discrimination
based on race, color, religion, sex or national origin.
Pregnancy Discrimination Act of 1978, codified at 42 U.S.C. § 2000e(k), as
amended, Civil Rights Act of 1964, and the Civil Rights Act of 1991, for
employment discrimination based on pregnancy.
5.
Venue is invoked pursuant to 28 U.S.C. s 1391.
6.
Defendant’s conduct is discriminatory with respect to the following (check all that
apply):
(A)
(B)
(C)
(D)
(E)
(F)
7.
My race or color.
My religion.
My sex (or sexual harassment).
My national origin.
My pregnancy.
Other:
.
The conduct complained of in this action involves:
(A)
(B)
(C)
(D)
(E)
(F)
(G)
Failure to employ.
Termination of employment.
Failure to promote.
Unequal terms and conditions of employment.
Reduction in wages.
Retaliation.
Other acts as specified below:
FORM E(1)(b).2
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8.
FACTS
Set forth the facts of your case which substantiate your claims. List the events in the
order they happened, naming defendants involved, dates and places.
Note: You must include allegations of wrongful conduct as to EACH and EVERY
defendant in your complaint. (You may use additional sheets as necessary).
9.
CAUSES OF ACTION
Note: You must clearly state each cause of action you assert in this lawsuit.
FIRST CAUSE OF ACTION
FORM E(1)(b).3
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SECOND CAUSE OF ACTION
THIRD CAUSE OF ACTION
10.
I filed charges with the New York State Division on Human Rights, the New York City
Commission on Human Rights or Equal Employment Opportunity Commission regarding
the alleged discriminatory acts on or about:
(Provide Date)
11.
The Equal Employment Opportunity Commission issued a Notice-of-Right-to-Sue letter
(copy attached) which was received by me on or about:
(Provide Date)
12.
The plaintiff is an employee within the meaning of 42 U.S.C. § 2000e(f).
13.
The defendant(s) is (are) an employer, employment agency, or labor organization within
the meaning of 42 U.S.C. § 2000e(b), (c), or (d).
14.
The defendant(s) is (are) engaged in commerce within the meaning of 42 U.S.C.
§ 2000e(g).
FORM E(1)(b).4
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15.
PRAYER FOR RELIEF
WHEREFORE, plaintiff(s) request(s) that this Court grant the following relief:
I declare under penalty of perjury that the foregoing is true and correct.
DATED:
Signature of Plaintiff(s)
(all Plaintiffs must sign)
FORM E(1)(b).5
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