Free INSTRUCTIONS FOR FILING A COMPLAINT FOR USE IN EMPLOYMENT DISCRIMINATION CASES - Alabama

UNITED STATES DISTRICT COURT MIDDLE DISTRICT OF ALABAMA INSTRUCTIONS FOR FILING A COMPLAINT FOR USE IN EMPLOYMENT DISCRIMINATION CASES ------------------------------------------READ CAREFULLY -----------------------------------------1. This packet consists of: 1 copy of an EEOC complaint form 1 copy of a summons form 1 copy of an in forma pauperis motion

2.

Your complaint must be clearly handwritten or typewritten and signed by each plaintiff. ALL copies of the complaint must be identical in wording to the original. It is not necessary to swear to the complaint under oath before a notary public. However, each plaintiff must attest under penalty of perjury that the complaint is true and correct. You are warned that any false statement of a material fact may subject you to prosecution and conviction. The Notice-of-Right-to-Sue letter issued by the EEOC must be attached to your complaint. All questions must be answered concisely in the proper space on the form. If you need additional space to answer a question, you may use the reverse side of the form or use an additional blank page. YOUR COMPLAINT SHOULD NOT CONTAIN LEGAL ARGUMENTS OR CITATIONS ­ YOU ARE ONLY REQUIRED TO GIVE FACTS. You must describe how each defendant is personally involved in the activities upon which your claim is based. Also, include any request for a jury trial. Upon receipt of the $350.00 filing fee, your complaint will be filed. If you are unable to pay the filing fee, you may petition the court to proceed in forma pauperis. If you must proceed in forma pauperis, you must complete, sign, and attest as true and correct under penalty of perjury the petition and financial affidavit. If there is more that one plaintiff, then each plaintiff must complete a separate petition. If you pay the $350.00 filing fee, you must also fill out 2 summons forms for each defendant you name in your complaint. Also, provide envelopes per defendant and postage for certified mail, return receipt requested and have the postage affixed to the envelopes. It is YOUR responsibility to notify the Clerk's Office in writting of ANY change of address you may have during the entire time this case remains open before the court. Failure to so advise the Clerk of your current address may result in the DISMISSAL of your case. When these forms are properly completed, mail them to the clerk's office. Your complaint will not be considered unless it conforms to these instructions.

3. 4.

5.

6.

7.

8. 9.

M/D-4

IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF ALABAMA _____________________ DIVISION _____________________________ _____________________________ _____________________________ PLAINTIFF v. _____________________________ _____________________________ _____________________________ DEFENDANT CASE ACTION NO.:______________________ JURY DEMAND (MARK ONE) G NO G YES

EEOC COMPLAINT

1. 2.

Plaintiff resides at _________________________________________________________ Defendant(s)' name(s)______________________________________________________ _________________________________________________________________________ Location of principal office(s) of the named defendant(s)___________________________ __________________________________________________________________________ __________________________________________________________________________ Nature of defendant(s)' business______________________________________________ __________________________________________________________________________ Approximate number of individuals employed by defendant(s)______________________

3.

This action is brought pursuant to Title VII of the Civil Rights Act of 1964 for employement discrimination. Jurisdiction is specifically conferred on the Court by 42 U.S.C. §2000e-5. Equitable and other relief are also sought under 42 §2000e-5(g). The acts complained of in this suit concern: 1. __ Failure to employ me. 2. __ Termination of my employment. 3. __ Failure to promote me. 4. __ Other acts as specified below:_______________________________________ __________________________________________________________________________ __________________________________________________________________________

4.

5.

Plaintiff is: A. ___ Presently employed by the defendant. ___ Not presently employed by the defendant. The dates of employement were ________________________________ Employment was terminated because: (1) (2) (3) _____ Plaintiff was discharged. _____ Plaintiff was laid off. _____ Plaintiff left job voluntarily.

6.

Defendant(s)' conduct is discriminatory with respect to the following: A. ____ My race. B. ____ My religion. C. ____ My sex. D. ____ My national origin. E. ____ Other, as specified below:________________________________________ __________________________________________________________________________ __________________________________________________________________________

7.

The name(s), race, sex, and the position or title of the individual(s) who allegedly discriminated against me during the period of my employment with the defendant company is (are) __________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ The alleged discrimination occurred on or about _________________________________. The nature of my complaint, i.e., the manner in which the individual(s) named above discriminated against me in terms of the conditions of my employment, is as follows: __________________________________________________________________________ ________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ The alleged illegal activity took place at ________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________

8. 9.

10.

11.

I filed charges with the Equal Employment Opportunity Commission regarding defendant(s)' alleged discriminatory conduct on or about ____________________________________. I have attached a copy of the Notice-of-Right-to-Sue letter issued by the Equal Employment Opportunity Commission. The letter was received by me on ____________. I seek the following relief: A. B. ___ Recovery of back pay. ___ Reinstatement to my former job, and any other relief as may be appropriate, including injunctive orders, damages, costs, and attorneys fees. __________________________________ Signature of Plaintiff __________________________________ __________________________________ __________________________________ Address & Telephone Number of Plaintiff

12.

Date:____________________________