Free Opening Brief in Support - District Court of Delaware - Delaware

Case 1:04-cv-01450-JJF Document 30-28 Filed 10/31/2005 Page1 014

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Case 1:04-cv-01450-JJF Document 30-28 Fnled 10/31/2005 Pagé
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EEOC AFFIDAVIT
Charge #: |Date: November 18, 2003
Charging Party Information
Name: Ms. Cassandra Johnson
Street: 120 Locust St. City: Smyrna,
County: Kent State: DE Zip: 19977
Tel (H): (302) 653—4192 Tel (W): (302} 67B—4223
» DOB: 6/12/1972 Sex: Female Race: Black
Nat'l Origin: U.S. SSN: 222-58-5340
Contact Person
Name: Mr. Kevin Johnson
Tel (H): (410) 224-4417 Tel (W): N/A
Address: NIA
Employment Information -
Date of Hire: 9/1996
Date of Termination: NIA
Date of Alleged Violation: ;e·n—geing_l1/xr/xg? ##4 "
Relief Sought: Compensatory & Punitive
Check One: EQ working [] not working [] sought employment at
Respondent Information
Name: Sams Club #6330
Address: 1527 N. Dupont HWY. Dover, DE 19901
Type of Business: Retail Store
Size of Business: 25+
Basic Charge Data
Receiving Office: 17C Intake unit: 1
Accountable Office: 17C Intake Officer: AB
Initial Inquiry: ll/18/2003 Respondent Type: E
Received this Office: November 10, County: 001
2003
Source of Complaint: A SMSA: 9160
Federal Referral Transfer: SIC: 530
Alleged Basis: GF Federal Agency:
Alleged Issues: P3 _ \
Wal-Mart—J0hnson
01274

Case 1 :04-cv-01450-JJF Document 30-28 Filed 10/31 /2005 Page 3 of 4
(1 `ONTINUATION OF AFFIDAVIT i
1. Coverage/Rospondenfs Business (tlof employees/nature of business/Charging Party's
Department/Title/Identity Others of Same Title):
Sam Club store # 6330. 50+, `Hro Department
2. Relevant Work History (Qualilied, Requirements of Position, Date of Hire, Employment History, Prior
Disciplines):
Employed by Respondent for 7 years and in the 'lire Deparlrnent for 3 years
3. Personal Harm (Discharge, Demoted, Sexually Harassed, etc., dates of harm, alleged harassers with
titles, where did the harm occur, harm was based on what basis):
Not being pald the same as my male co—worters '
4. R's Explanation for the alleged harm and its policies and practices (written/verbal, who (name/title)
gave explanation):
Please see attached
5. Direct Evidence (verbalfwritten statements/documents, name/title person (s) made discriminatory
statementslwhen and where statements were made
Please see attached
6. Witnesses (name, title, address/phone number, what information can witness provide):
Please see attached
7. Comparative Data (identify all similarly situated persons, describe treatment o_|' comparator (s), how
‘ does CP know this infomation, qualilications of comparator):
Please see attached
8. Class Harm (identify (name, title, dates & circumstances) all other of same EE0 class as CP also
harmed by Respondent):
Please see attached
9. Remedylllelief Sought (describe what remedy or terms of settlement CP is seeking, and describe why
CP believes he/she is entitled to provided remedy):
Please see attached
F
D AND IN _
Wal-Mart-Johnson
O1 275

Case 1 :04-cv-01450-JJF Document 30-28 Filed 10/31 /2005 Page 4 of 4
%UNT|NUATION OF EEOC AFFIDAQ?
SIGNATURE PAGE
This Aftidavit has been prepared by a representative of the EEOC in an official capacity as part ot an
investigation. It has been read by me and I agree with the contents. Where changes (if any) were
necessary, I have initiated such changes.
lf affidavit is signed before a Notary Public, complete the following:
Eegnature of Img ewee
Stale of My Commission expires
County of
Subscribed and swom to before me on
This day of ,
20 , at . Sigiatwe of Notary Public
Sign below if affidavit is sigied before an EEO Representative:
ldeclareunderthe •= B lhdlhe r >s ` sISlI1JE3IldCOTTBt1.
one siermune OF wmiess snewnune or eeoc nemssemxrive
. I! . I '4u4 z
PRIVACYACTSTATEMENT: (11iIsform is covered byth•Priv¤qActot1974, PubIicLnr93-579. Authorityforreqnnsting
anousesofthepersonatdateareghaenbelovv.)
1. FORM NUM TE: EEOC FORM 133, EEOC AFFIDAVIT, August 19BB. -
2. AUTHORl1Y:4zUSC 20¤0e(9),29USC 2Il1,29USC621.
3. PRINCIPAL PURPOSES. Provides a standardized fomiat for obtaining from the Charging Party, Respondent and
Wlmesssmmmsutementsofinfomationrelevaatmadurgeofdiscrinimdon.
l 4. ROUTINEUS .'Ihese¤II`idavitsareusedto:(1)maI¤e¤n¤I'ficia|detenninationregardingtI1eval'•dityoIttiecharge
‘ ot discrinination; (2) guicb the Corr¤nission's investigatory activity; and {3) in Title VII, Equd Pay Act, and Age
Discrinination in Employment Act litigation, to inpeach or substantiate a witness’s testimony.
5. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL FOR NOT PROVIDING
INFORMAUON: Voluntary. Fa¤1ure to provide an affidavit has no effect upon the iurisdiction ot the Commission to
process e charge. However, sworn statements submitted by the parties are, of course, relied upon more heavily
than unswom statements in making determination as to the existence of unlawful
_ ssoc soma no nn:) A ‘
Wal-Mart-Johnson
01276