Free Employment Discrimination Complaint - Washington


File Size: 123.8 kB
Pages: 3
File Format: PDF
State: Washington
Category: Court Forms - Federal
Word Count: 248 Words, 1,602 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.wawd.uscourts.gov/documents/ReferenceMaterials/Forms/EmpDiscrim.pdf

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Preview Employment Discrimination Complaint
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Defendant(s), Name, address and phone number of Plaintiff: v. Plaintiff(s), UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF WASHINGTON
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EMPLOYMENT DISCRIMINATION COMPLAINT

Name and address of Defendant(s): (List additional defendants' names and addresses on a separate sheet of paper.)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

This action is brought pursuant to Title VII of the Civil Rights Act of 1964 for employment discrimination. Jurisdiction is conferred on this Court by 42 U.S.C. Section 2000e-5. Equitable and other relief is sought under 42 U.S.C. Section 2000e-5(g). The acts complained of in this suit concern:

Defendant's conduct is discriminatory with respect to the following:

The basic facts surrounding my claim of discrimination are:

The alleged discrimination occured on or about:

I filed charges with the Federal Equal Employment Opportunity Commission (or Washington State Human Rights Commission) regarding defendant's alleged discriminatory conduct on or about: The Equal Employment Opportunity Commission issued a Notice of Right to Sue Letter (please attach copy), which was received by me on or about:

1 WHEREFORE, plaintiff prays that the Court grant the following relief: 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Plaintiff's Name Signature of Plaintiff DATED: