Free Civil Complaint Pursuant to Title VII - New York


File Size: 13.1 kB
Pages: 5
Date: May 12, 2005
File Format: PDF
State: New York
Category: Court Forms - Federal
Author: mcallister
Word Count: 480 Words, 2,978 Characters
Page Size: Letter (8 1/2" x 11")
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http://www.nynd.uscourts.gov/documents/CivilComplaintPursuanttoTitleVIICivilRightsAct_000.pdf

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Preview Civil Complaint Pursuant to Title VII
UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF NEW YORK ) ) ) ) ) ) )

Plaintiff(s) vs.

Civil Case No.: CIVIL COMPLAINT PURSUANT TO TITLE VII OF THE CIVIL RIGHTS ACT, AS AMENDED

Defendant(s)

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

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. 6.

Venue is invoked pursuant to 28 U.S.C. s 1391. Defendant's conduct is discriminatory with respect to the following (check all that apply): (A) (B) (C) (D) (E) (F) My race or color. My religion. My sex (or sexual harassment). My national origin. My pregnancy. Other:

.

7.

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

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

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. 13. The plaintiff is an employee within the meaning of 42 U.S.C. 2000e(f). 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). The defendant(s) is (are) engaged in commerce within the meaning of 42 U.S.C. 2000e(g). FORM E(1)(b).4

14.

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