Free PDF - Indiana

UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF INDIANA _____________________________, ) Plaintiff, vs. _____________________________, ) Defendant. ) ) ) ) ) ) )

Cause No.

EMPLOYMENT DISCRIMINATION COMPLAINT
Plaintiff brings a complaint against defendant ______________________ for discrimination as set forth below. Plaintiff ____ DOES ____ DOES NOT (indicate which) demand a jury trial.

I. PARTIES
Plaintiff's Name, Address, and Phone Number:

Defendant's Name and Address:

II. JURISDICTION
1. This complaint is brought pursuant to: _______ Title VII of the Civil Rights Act of 1964, as amended, and jurisdiction is based on 42 U.S.C. §2000e-5 and 28 U.S.C. §1331; _______ The Age Discrimination in Employment Act (29 U.S.C. § 621), and jurisdiction is based on 28 U.S.C. § 1331;

_______ The Americans with Disabilities Act (42 U.S.C. § 12101), and jurisdiction is based on 28 U.S.C. § 1331; _______ The Rehabilitation Act (29 U.S.C. § 701, et seq.), and jurisdiction is based on 28 U.S.C. § 1331; _______ Equal rights under law (42 U.S.C. § 1981), and jurisdiction is based on 28 U.S.C. § 1331; _______ Other (list):

2. Plaintiff ____ DID ____ DID NOT (indicate which) timely file a charge of discrimination with the Equal Employment Opportunity Commission or the Indiana Civil Rights Commission. [Attach a copy of charge to this complaint]. 3. Plaintiff's Right to Sue Notice from the Equal Employment Opportunity Commission or the Indiana Civil Rights Commission was received on or about ______________________ (insert date). [Attach a copy of Notice of Right to Sue to this complaint].

III. STATEMENT OF LEGAL CLAIM
Plaintiff is entitled to relief in this action because:

IV. FACTS IN SUPPORT OF COMPLAINT

V. PRAYER FOR RELIEF
Based on the foregoing, plaintiff seeks the following relief:

(Use additional sheets if necessary.)

VI. SIGNATURE
Signed this _______ day of _____________________, 20 __.

__________________________________ (Signature of Plaintiff)