SD03 (Rev. 9/97) IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF OHIO _____________________________ (Enter above the full name of the plaintiff in this action) : v. _____________________________ _____________________________ _____________________________ (Enter the above full name of the defendant or defendants in this action) : : : Case No. ___________________ COMPLAINT UNDER 42 U.S.C. 2000e-5(f)(1) : I. Parties (In item A below, place your name in the first blank and place your present address and telephone number (or telephone number where you can be reached) where indicated in the following blanks.) A. Name of Plaintiff ___________________________________________________ Address __________________________________________________________ Telephone No. _____________________________________________________ Under 42 U.S.C. 2000e-5(f)(1) suit may only be "brought against the respondent named in the charge" of unlawful employment practice you filed with the Ohio Civil Rights Commission and/or the Equal Employment Opportunity Commission. ATTACH A COPY OF THE CHARGE YOU FILED WITH THE OHIO CIVIL RIGHTS COMMISSION AND/OR THE EQUAL EMPLOYMENT OPPORTUNITY COMMISSION TO THIS COMPLAINT. In item B below list the name and address of the employer against whom you filed the charge. In item C below, list the name and address of any other person(s) you named in the charge you filed with the Ohio Civil Rights Commission and/or the Equal Employment Opportunities Commission. B. Defendant _________________________________________________________ (As named in the attached charge) Address __________________________________________________________ __________________________________________________________ -1- American LegalNet, Inc. www.FormsWorkflow.com C. Additional defendants (as named in the attached charge): __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ II. The Court has jurisdiction under 42 U.S.C. §2000e-5(f)(1). A. The date the notice of right to sue was issued by the Equal Employment Opportunity commission was _________________________________________. The date you received the notice of right to sue was _______________________. ATTACH A COPY OF THE NOTICE OF RIGHT TO SUE TO THIS COMPLAINT. B. C. III. Statement of Claim The Equal Employment Opportunities Act provides, in part, that (a) it shall be an unlawful employment practice for an employer -(1) to fail or refuse to hire or to discharge any individual, or otherwise to discriminate against any individual with respect to his compensation, terms, conditions, or privileges of employment, because of such individual's race, color, religion, sex, or national origin. 42 U.S.C. §2000e-2(a)(1). Other unlawful employment practices are set out in 42 U.S.C. §2000e-2(a) through (d). State here as briefly as possible the facts of your case. Describe how each defendant is involved. Include also the names of other persons involved, dates, and places. Do not give any legal arguments or cite any cases or statutes. If you intend to allege a number of related claims, number and set forth each claim in a separate paragraph. Use as much space as you need. Attach an extra sheet if necessary. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ -2- American LegalNet, Inc. www.FormsWorkflow.com ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ IV. Relief (State briefly exactly what you want the Court to do for you. Make no arguments. Cite no cases or statutes.) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ____________________________________ (Signature of Plaintiff) I declare under penalty of perjury that the foregoing is true and correct. ________________________________ (Date) _______________________________ (Signature of Plaintiff) -3- American LegalNet, Inc. www.FormsWorkflow.com