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UNITED STATES DISTRICT COURT FOR THE DISTRICT OF UTAH

INFORMATION FOR FILING AN EMPLOYMENT DISCRIMINATION COMPLAINT

Office of the Clerk of Court

INTRODUCTION This information packet is designed to help you file an employment discrimination lawsuit in federal court without the help of a trained and licensed attorney. When you represent yourself in a lawsuit you are known as a pro se litigant, or a person who is proceeding pro se. In order to start a lawsuit based on a claim of employment discrimination, you must prepare and file with the court what is known as a complaint. This packet of instructions is designed to help you prepare an employment discrimination complaint under Title VII of the Civil Rights Act of 1964. For information on how to actually file the complaint with the court after you have prepared it and how to proceed in your lawsuit, you should obtain and read the Pro Se Litigant Guide, which is available at the clerk's office of the U.S. District Court for the District of Utah, located in suite 150 of the Frank E. Moss U.S. Courthouse, 350 South Main in Salt Lake City, Utah, 84101. A sample complaint form is included in this packet to help you to prepare your complaint. Your complaint must be typewritten or legibly handwritten. All questions must be answered clearly in the correct space on the form. If you need extra space to answer a question, you may use additional pages of 8.5" x 11" size paper. The additional page(s) must be legible, and must indicate which question you are answering. If you are suing more than one person, you should state clearly which defendant you accuse of each act.

PROCEDURES TO FOLLOW BEFORE THE COMPLAINT IS FILED Before discussing how to actually prepare a complaint, there is some important information you must know about employment discrimination cases. Prior to filing an employment discrimination complaint in federal court, the plaintiff is required to follow specific administrative procedures. Note: This information packet does not provide a complete statement of the law on the administrative procedures to follow before filing an employment discrimination complaint in federal court. The procedures are complicated and it is your responsibility to make sure that all procedures are followed correctly and within the applicable time limit. If you wish to file an employment discrimination case in this court, you first must file your charges with the Anti-Discrimination Division of the Utah State Industrial Commission (UADD). In most cases, the UADD will review your charges and, barring complications, the Equal Employment Opportunity Commission (EEOC) will issue you a Notice of Right to Sue indicating that (i) the administrative process has been completed, and (ii) no further action will be taken on behalf of the EEOC. Once this notice is issued, you have a limited time period within which to file your lawsuit; failure to file a complaint in that time period will result in having your cause of action dismissed by this court. A Notice of Right to Sue is not issued where the charges allege employment discrimination based on age. However, not having such a notice will not prevent you from filing and employment discrimination complaint based on age. 1

The Notice of Right to Sue will indicate that you, as the litigant, have the right to request the court to appoint an attorney to represent you if, for financial reasons, you are unable to retain you own attorney. You should bear in mind that in this court, a request for appointment of an attorney will be considered only after a complaint has been filed and is pending before the court, and that the court does not have to grant your request.

PREPARING THE COMPLAINT 1. To assist a party appearing pro se in filing an employment discrimination complaint, the office of the clerk has prepared a complaint form, a copy of which is attached to this information packet. The instructions in this section correspond by name to the sections in the sample complaint form. 2. If you need more space than the sample complaint form provides to record details, you should use additional sheets the same size as the complaint. You may attach to your complaint copies of documents that, in judgment, support your claims. A good example of such an exhibit in employment discrimination cases is a copy of the Notice of Right to Sue. These attachments are called exhibits. It is important that you not attach exhibits that do not specifically support or strengthen your case. Generally such exhibits will not help your case, and they will add to the time it takes the judge to review your complaint. A. Caption and Heading: Before your case can be filed with the clerk's office, the first page of your complaint must have your name, address and telephone number at the top of the complaint as part of the heading. This is referred to as the case caption and heading. The case caption also must indicate the Division of the District of Utah in which the case originates. Determining this is relatively easy. Northern Division: If the defendant(s) reside in, or if the action on which the lawsuit is based occurred in one of the following counties, it is a Northern Division case: Box Elder, Cache, Rich, Weber, Davis, or Morgan. Central Division: If the defendant(s) reside in, or if the action occurred in one of the following counties, it is a Central Division case: Beaver, Carbon, Daggett, Duchesne, Emery, Garfield, Grand, Iron, Juab, Kane, Millard, Piute, Salt Lake, San Juan, Sanpete, Sevier, Summit, Tooele, Uintah, Utah, Wasatch, Washington, or Wayne. In the caption, you must also add your name as the plaintiff and the names of the people you are naming as defendants on the lines provided.

B. Jurisdiction: In this section, you inform the court why the case should be heard in federal court rather than state court or some other forum. In the attached complaint, the jurisdiction section has been completed for you. The jurisdiction of this court to hear these 2

actions is based upon 42 U.S.C. § 2000e-5 and, when the discrimination is based on age, 29 U.S.C. § 626(c)(1). U.S.C. stands for "United States Code," which is a collection of all the federal laws in the country. C. Parties: Next, you name the parties. As the person initiating the lawsuit, you are the plaintiff and must identify yourself as such. For each defendant named in your complaint, you should list their current address and a description of their employment. D. Nature of the Case: You can complete this section by responding to the series of questions the form asks. Your answers describe the basis of your claim. Again, if you are filing this action because you have been discriminated by reason of your age, you may not have received a "Notice of Right to Sue." If you did not, you still are able to file the action; question five requires the Notice in all other employment discrimination actions. Question six can be answered by checking one or more of the types of discriminatory acts that are listed. If, in answering question seven, you feel that the basis of the discrimination is something other than the ones listed, you can add the grounds for your suit. E. Cause of Action: In this section, you are required to provide specific details of precisely how you were discriminated against in your employment. This description should include references to relevant dates, times, and locations. It should explain to the court what happened by specifically describing each defendant's behavior or action and how that behavior or action -- or lack of action -- constituted discrimination against you. You are not required to cite other cases in the law or to make a legal argument. However, you must be specific about (i) the particulars of the event, (ii) each defendant's misconduct, and how such misconduct resulted in unlawful discriminatory action against you. Where your complaint includes more than one incident, you should clearly distinguish between them by preparing a separate description -- usually a paragraph -- for each incident. Each incident should be identified as a separate count, and each count must include appropriate facts and evidence in support of the claims made in the count. Each incident must be clearly and specifically described; it should include the relevant time, date, and location. Each incident description also should clearly identify the relevant defendant and what that defendant's role was in the incident. If your case involves an allegation that two or more defendants jointly conspired to discriminate against you, you must, in a separate count, state the approximate date the defendants entered into the conspiracy. Moreover, in the supporting facts, you should refer to any evidence you have that the defendants indeed did conspire together to unlawfully discriminate against you. F. Injury: In this section you must state as specifically as possible the actual injury you suffered from the action of the defendant that resulted in the unlawful discrimination. For example, if you claim that you were improperly denied a promotion, you should document the financial and other losses that resulted from the denial. Simply stating that you have been 3

discriminated against in your employment is insufficient and will do little to persuade the judge that you have suffered an injury that merits the attention of the court. As the plaintiff, you must explain to the judge how the action of the defendant(s) was discriminatory and harmed you. G. Previous Lawsuits and Administrative Relief: It is important, in this section, that you alert the judge to any other case in which you are or were a party that may be connected with the case you now are filing. If, for example, you filed an earlier case that includes some of the same facts and events you rely on for this case, the court needs to know. If you have submitted a formal complaint to an agency of the state on the issues you raise in this case, or if you previously asked for or participated in an administrative review process to attempt to solve the problem, you must tell the court the results, if any, of your action. H. Request for Relief: In this section, you describe for the judge the result or relief you seek as a result of your lawsuit. The relief you request must be related specifically to the injury you have suffered.

I. Declaration Under Penalty of Perjury: You must sign your complaint and file it with the clerk of court. When you do, you are making a declaration under law to the court that everything in your complaint is true. It is important for you to realize that the judge assigned to your case can order sanctions or penalties against you or any other party that files complaints or pleadings that are frivolous, without merit, based on false or misleading information, etc. These sanctions or penalties can take many forms. Examples include dismissing your case, assessing fines, requiring you to pay the attorney costs for the opposing party, limiting your filing privileges in federal court, etc. If you intentionally make false statements in documents you file with the clerk, you may be charged with criminal lying, or perjury, an offense with potentially serious consequences. FILING THE COMPLAINT You may file the complaint with the court by delivering it or mailing it to the Office of the Clerk of Court, Frank E. Moss United States Courthouse, Room 150, 350 South Main Street, Salt Lake City, Utah 84101. Whether you deliver or mail your complaint to the court, you must submit (i) an original and one copy of the complaint, (ii) a completed cover sheet, a copy of which can be obtained from the clerk's office, and (iii) the $250 filing fee. The $250 filing fee can be waived by the court if you complete, and the court accepts, an application to proceed in forma pauperis. An application to proceed in forma pauperis asks the court to have the government pay your filing fee for you because you do not have the money to do so yourself. Applications to proceed in forma pauperis are available at the clerk's office, and are also available as part of the court's Pro Se Litigant Guide. You should submit your application to proceed in forma pauperis along with your complaint to the clerk's office. If the court grants your application, you will be able to proceed without paying the $250 filing fee. If the court does not grant your application, you must pay the $250 filing fee within two weeks of 4

the denial of your application or your complaint will not be accepted by the court. Note: Each defendant named in your lawsuit must be notified of your lawsuit in a specific manner governed by law. You should refer to the court's Pro Se Litigant guide for information on this matter.

5

Name: Address:

Telephone: ________________________________________________________________________ IN THE UNITED STATES DISTRICT COURT DISTRICT OF UTAH - _____________DIVISION ________________________________________________________________________ ________________________ : : Plaintiff, : : COMPLAINT v. : : ________________________ : ________________________ : ________________________ : Civil No. ________________________ : ________________________ : : Defendant(s). : : ________________________________________________________________________

A. JURISDICTION This action is brought pursuant to Title VII of the Civil Rights Act of 1964 as amended, for employment discrimination. Jurisdiction is specifically conferred on this Court by 42 U.S.C. § 2000e(5). Equitable and other relief are also sought under 42 U.S.C. § 2000e(5)(g). Jurisdiction is also based on 28 U.S.C. 1331, 1343 and 42 U.S.C. §§ 1981 et seq. Where employment discrimination based upon age is alleged, jurisdiction is conferred by 29 U.S.C. § 627(C) (d) and appropriate relief is also sought. B. PARTIES

1.

Name of plaintiff: Present mailing address:

____________________________________ ____________________________________ ____________________________________ 6

____________________________________ 2. Name of first defendant: Present mailing address or business location: ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________

3.

Name of second defendant: Present mailing address or business location:

4.

Name of third defendant: Present mailing address or business location:

(Use additional sheets if necessary.) C. NATURE OF CASE 1. The address at which I sought employment or was employed by the defendant(s) is: ____________________________________ ____________________________________ ____________________________________ ____________________________________

2.

The discriminatory acts occurred on or about: ____________________________________ (Month, Day, Year) I filed charges with the Anti Discrimination Division of the Utah State Industrial Commission regarding the defendant's discriminatory conduct on or about: ____________________________________ (Month, Day, Year) I filed charges with the Equal Employment Opportunity Commission regarding the 7

3.

4.

defendant's discriminatory conduct on or about: ____________________________________ (Month, Day, Year) 5. The Equal Employment Opportunity Commission sent the attached "Notice of Right to Sue" which I received on: ____________________________________ (Month, Day, Year) (Please attach the "Notice of Right to Sue" to this complaint.)

6.

The discriminatory acts which are the basis of this suit are: a._______ b._______ c._______ d._______ Failure to employ me Termination of my employment Failure to promote me Other acts (Be specific: attach an additional sheet if necessary)

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 7. Defendant's conduct is discriminatory with respect to: a._______ b._______ c._______ 8. my race my color my sex d._______ e._______ f._______ my religion my national origin my age

I believe that the defendant is still committing these acts against me. _____ yes ______no

D. CAUSE OF ACTION 1. I allege that the defendant has discriminated against me and that the following facts for the basis for my allegations: a. (1) (2) do. 8 Count I:_______________________________________________ Supporting Facts: (Describe exactly what each defendant did or did not

State the facts clearly, in your own words without citing any legal authority. Use additional sheets if necessary.) ______________________________________________________ ______________________________________________________ ______________________________________________________ b. (1) (2) Count II:_______________________________________________ Supporting Facts: ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________

E. INJURY 1. How have you been injured by the actions of the defendant(s)? ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ F. REQUEST FOR RELIEF 2. I believe I am entitled to the following relief: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ DECLARATION UNDER PENALTY OF PERJURY The undersigned declares under penalty of perjury that he/she is the plaintiff in the above action, that he/she has read the above complaint and that the information contained therein is true and correct. 28 U.S.C. §1746; 18 U.S.C. § 1621 9

Executed at______________on_____________, 20___. (Location)

____________________________________ Signature

10

OJS 44 (Rev. 11/04)

CIVIL COVER SHEET

The JS 44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as required by law, except as provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for the purpose of initiating the civil docket sheet. (SEE INSTRUCTIONS ON THE REVERSE OF THE FORM.)

I. (a)

PLAINTIFFS

DEFENDANTS

(b) County of Residence of First Listed Plaintiff
(EXCEPT IN U.S. PLAINTIFF CASES)

County of Residence of First Listed Defendant
(IN U.S. PLAINTIFF CASES ONLY) NOTE: IN LAND CONDEMNATION CASES, USE THE LOCATION OF THE LAND INVOLVED.

(c) Attorney's (Firm Name, Address, and Telephone Number)

Attorneys (If Known)

II. BASIS OF JURISDICTION
'1
U.S. Government Plaintiff

(Place an "X" in One Box Only)

III. CITIZENSHIP OF PRINCIPAL PARTIES(Place an "X" in One Box for Plaintiff
(For Diversity Cases Only) PTF Citizen of This State ' 1 DEF ' 1 and One Box for Defendant) PTF DEF Incorporated or Principal Place ' 4 '4 of Business In This State Incorporated and Principal Place of Business In Another State Foreign Nation

' 3 Federal Question
(U.S. Government Not a Party)

'2

U.S. Government Defendant

' 4 Diversity
(Indicate Citizenship of Parties in Item III)

Citizen of Another State

' 2 ' 3

' 2 ' 3

' 5 ' 6

' 5 ' 6

Citizen or Subject of a Foreign Country

IV. NATURE OF SUIT
CONTRACT

(Place an "X" in One Box Only) TORTS

FORFEITURE/PENALTY

BANKRUPTCY

OTHER STATUTES

' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' '

110 Insurance 120 Marine 130 Miller Act 140 Negotiable Instrument 150 Recovery of Overpayment & Enforcement of Judgment 151 Medicare Act 152 Recovery of Defaulted Student Loans (Excl. Veterans) 153 Recovery of Overpayment of Veteran's Benefits 160 Stockholders' Suits 190 Other Contract 195 Contract Product Liability 196 Franchise REAL PROPERTY 210 Land Condemnation 220 Foreclosure 230 Rent Lease & Ejectment 240 Torts to Land 245 Tort Product Liability 290 All Other Real Property

' ' ' ' ' ' ' ' ' ' ' ' ' ' ' '

PERSONAL INJURY 310 Airplane 315 Airplane Product Liability 320 Assault, Libel & Slander 330 Federal Employers' Liability 340 Marine 345 Marine Product Liability 350 Motor Vehicle 355 Motor Vehicle Product Liability 360 Other Personal Injury CIVIL RIGHTS 441 Voting 442 Employment 443 Housing/ Accommodations 444 Welfare 445 Amer. w/Disabilities Employment 446 Amer. w/Disabilities Other 440 Other Civil Rights

PERSONAL INJURY ' 362 Personal Injury Med. Malpractice ' 365 Personal Injury Product Liability ' 368 Asbestos Personal Injury Product Liability PERSONAL PROPERTY ' 370 Other Fraud ' 371 Truth in Lending ' 380 Other Personal Property Damage ' 385 Property Damage Product Liability PRISONER PETITIONS

' 610 Agriculture ' 620 Other Food & Drug ' 625 Drug Related Seizure ' ' ' ' ' ' ' ' ' ' '
of Property 21 USC 881 630 Liquor Laws 640 R.R. & Truck 650 Airline Regs. 660 Occupational Safety/Health 690 Other LABOR 710 Fair Labor Standards Act 720 Labor/Mgmt. Relations 730 Labor/Mgmt.Reporting & Disclosure Act 740 Railway Labor Act 790 Other Labor Litigation 791 Empl. Ret. Inc. Security Act

' 422 Appeal 28 USC 158 ' 423 Withdrawal
28 USC 157 PROPERTY RIGHTS

' 820 Copyrights ' 830 Patent ' 840 Trademark
SOCIAL SECURITY 861 HIA (1395ff) 862 Black Lung (923) 863 DIWC/DIWW (405(g)) 864 SSID Title XVI 865 RSI (405(g)) FEDERAL TAX SUITS ' 870 Taxes (U.S. Plaintiff or Defendant) ' 871 IRS--Third Party 26 USC 7609

' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' '

' ' ' ' '

' 510 Motions to Vacate ' ' ' ' '
Sentence Habeas Corpus: 530 General 535 Death Penalty 540 Mandamus & Other 550 Civil Rights 555 Prison Condition

400 State Reapportionment 410 Antitrust 430 Banks and Banking 450 Commerce 460 Deportation 470 Racketeer Influenced and Corrupt Organizations 480 Consumer Credit 490 Cable/Sat TV 810 Selective Service 850 Securities/Commodities/ Exchange 875 Customer Challenge 12 USC 3410 890 Other Statutory Actions 891 Agricultural Acts 892 Economic Stabilization Act 893 Environmental Matters 894 Energy Allocation Act 895 Freedom of Information Act 900Appeal of Fee Determination Under Equal Access to Justice 950 Constitutionality of State Statutes

V. ORIGIN
'1
Original Proceeding

' 2

(Place an "X" in One Box Only)

Transferred from ' 6 Multidistrict another district Removed from Remanded from Reinstated or (specify) State Court Appellate Court Reopened Litigation Cite the U.S. Civil Statute under which you are filing (Do not cite jurisdictional statutes unless diversity):

' 3

'4

' 5

' 7

Appeal to District Judge from Magistrate Judgment

VI. CAUSE OF ACTION

Brief description of cause: DEMAND $ CHECK YES only if demanded in complaint: ' Yes ' No JURY DEMAND: DOCKET NUMBER

' CHECK IF THIS IS A CLASS ACTION VII. REQUESTED IN UNDER F.R.C.P. 23 COMPLAINT: VIII. RELATED CASE(S) (See instructions): JUDGE IF ANY
DATE

SIGNATURE OF ATTORNEY OF RECORD

FOR OFFICE USE ONLY RECEIPT # AMOUNT APPLYING IFP JUDGE MAG. JUDGE

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JS 44 Reverse (Rev. 11/04)

INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET FORM JS 44
Authority For Civil Cover Sheet
The JS 44 civil cover sheet and the information contained herein neither replaces nor supplements the filings and service of pleading or other papers as required by law, except as provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for the purpose of initiating the civil docket sheet. Consequently, a civil cover sheet is submitted to the Clerk of Court for each civil complaint filed. The attorney filing a case should complete the form as follows: I. (a) Plaintiffs-Defendants. Enter names (last, first, middle initial) of plaintiff and defendant. If the plaintiff or defendant is a government agency, use only the full name or standard abbreviations. If the plaintiff or defendant is an official within a government agency, identify first the agency and then the official, giving both name and title. (b) County of Residence. For each civil case filed, except U.S. plaintiff cases, enter the name of the county where the first listed plaintiff resides at the time of filing. In U.S. plaintiff cases, enter the name of the county in which the first listed defendant resides at the time of filing. (NOTE: In land condemnation cases, the county of residence of the "defendant" is the location of the tract of land involved.) (c) Attorneys. Enter the firm name, address, telephone number, and attorney of record. If there are several attorneys, list them on an attachment, noting in this section "(see attachment)". II. Jurisdiction. The basis of jurisdiction is set forth under Rule 8(a), F.R.C.P., which requires that jurisdictions be shown in pleadings. Place an "X" in one of the boxes. If there is more than one basis of jurisdiction, precedence is given in the order shown below. United States plaintiff. (1) Jurisdiction based on 28 U.S.C. 1345 and 1348. Suits by agencies and officers of the United States are included here. United States defendant. (2) When the plaintiff is suing the United States, its officers or agencies, place an "X" in this box. Federal question. (3) This refers to suits under 28 U.S.C. 1331, where jurisdiction arises under the Constitution of the United States, an amendment to the Constitution, an act of Congress or a treaty of the United States. In cases where the U.S. is a party, the U.S. plaintiff or defendant code takes precedence, and box 1 or 2 should be marked. Diversity of citizenship. (4) This refers to suits under 28 U.S.C. 1332, where parties are citizens of different states. When Box 4 is checked, the citizenship of the different parties must be checked. (See Section III below; federal question actions take precedence over diversity cases.) III. Residence (citizenship) of Principal Parties. This section of the JS 44 is to be completed if diversity of citizenship was indicated above. Mark this section for each principal party. IV. Nature of Suit. Place an "X" in the appropriate box. If the nature of suit cannot be determined, be sure the cause of action, in Section VI below, is sufficient to enable the deputy clerk or the statistical clerks in the Administrative Office to determine the nature of suit. If the cause fits more than one nature of suit, select the most definitive. V. Origin. Place an "X" in one of the seven boxes. Original Proceedings. (1) Cases which originate in the United States district courts. Removed from State Court. (2) Proceedings initiated in state courts may be removed to the district courts under Title 28 U.S.C., Section 1441. When the petition for removal is granted, check this box. Remanded from Appellate Court. (3) Check this box for cases remanded to the district court for further action. Use the date of remand as the filing date. Reinstated or Reopened. (4) Check this box for cases reinstated or reopened in the district court. Use the reopening date as the filing date. Transferred from Another District. (5) For cases transferred under Title 28 U.S.C. Section 1404(a). Do not use this for within district transfers or multidistrict litigation transfers. Multidistrict Litigation. (6) Check this box when a multidistrict case is transferred into the district under authority of Title 28 U.S.C. Section 1407. When this box is checked, do not check (5) above. Appeal to District Judge from Magistrate Judgment. (7) Check this box for an appeal from a magistrate judge's decision. VI. Cause of Action. Report the civil statute directly related to the cause of action and give a brief description of the cause. Do not cite jurisdictional statutes unless diversity. Example: U.S. Civil Statute: 47 USC 553 Brief Description: Unauthorized reception of cable service VII. Requested in Complaint. Class Action. Place an "X" in this box if you are filing a class action under Rule 23, F.R.Cv.P. Demand. In this space enter the dollar amount (in thousands of dollars) being demanded or indicate other demand such as a preliminary injunction. Jury Demand. Check the appropriate box to indicate whether or not a jury is being demanded. VIII. Related Cases. This section of the JS 44 is used to reference related pending cases if any. If there are related pending cases, insert the docket numbers and the corresponding judge names for such cases. Date and Attorney Signature. Date and sign the civil cover sheet.