Free Declaration in Support - District Court of California - California

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EEOCFORM131(5/Olpase 3 07 E I ISSIOHQ T
‘ I PERSON FILING CHARGE ' I,
I- Ms Anita Waller . Tl _ I
Lead Investigator Specialist ` Ei
I Fernando M. Darosa -
KASIER PERMANENTE T l r It
1950 Frshitiih Street, ts"' Floor H S PERSON l°"€°" °"" °"’?"") - A
Oakland, CA 94612 A El Claims To Be Aggrieved
I . E ls Filing on Behalf of Other(s)
[_ _] eeoc CHARGE No.
555-2006-00559 I I”rS
NOTICE OF CHARGE OF DISCRIMINATION
(See the enclosed for additional information)
This is notice that a charge of employment discrimination has been tiled against your organizatiorrggderz
I;] Title vii ofthe Civil Rights Act X The Americans with DisalIilities\AcI§ {Y IE Il iw ljlj
. i t i * We ss IJ IJ z ~ gi
I - I .I I 5—-——~--»-----».-»»s._ r l I I
I] The Age Discrimination in Employment Act E The Equal Pay Act
> . P V U I A j- A·v··.:»— ' . ·;¥
The boxes checked below apply to our handling of this charge: ~·* ~—· 2 I ' I M S N" I A » .[
1. E No action is required by you at this time. , ____,___ I
2. lj Please call the EEOC Representative listed below concerning the further handling of this charge.
3· EI Please provide by 10'MAY"06 a statement of your position on the issues covered by this charge, with copies of any
supporting documentation to the EEOC Representative listed below. Your response will—be placed in the tile and considered as we investigate
the charge. A prompt response to this request will make it easier to conclude our investigation.
4· Q Please respond fully by to the enclosed request for information and send your response to the EEOC
Representative listed below. Your response will be placed in the Hle and considered as we investigate the charge. A prompt response to this
request will make it easier lo conclude our investigation. ‘..V
5- X EEOC has a Mediation program that gives parties an opportunity to resolve the issues of a charge without extensive investigation or
expenditure of resources. If you would like to participate, please say so on the enclosed form and respond by 03,,MAY_06
l° Tina L. Bonaparte, ADR Coordinator, at (415) 625-5630
lf you DO NOT wish to try Mediation, you must respond to any request(s) madeabove by the date(s) specified there.
For further inquiry on this matter, please use the charge number shown above. Your position statement, your response to our request for information,
or any inquiry you may have should be directed to: .3.
Julian F. llllelendres. · Oakland Local Oftice - 555 fe
Investigator Support Asst 1301 Cray Street
EEOC Representative SI.IIt€ 1 170-N
kl 4 A it
Telephone (510) 6376242 Oa and, CA9 612 . it
EncIosure(s): ® Copy of Charge
CIRCUMSTANCES OF ALLEGED DISCRIMINATION
I;] RACE I:] coi.oR I;] sex I;] RELIGION I;] NATIONAL ORIGIN EI AGE _ I;] DISABILITY I:] RETALIATION El ornen
See enclosed co of char e of discrimination W » QI
` I —
‘ I `I
*
Date Name / Title of Authorized Official Signature ,» -· {7
‘ ;1;i
Joyce A. I-lendy, I ~. _ I A » if
Apr 18, 2006 Director I
K00503

E¤¤l¤S¤r¤ with EE¤Gase 3:07—cv—031 1!I Document 48-20 Filed 09/0!008 Page 2 of 4 _
Form 131 (5/01) _
~ INFORMATION ON CHARGES OF DISCRIMINATION 1
. . EEOC RULES AND REeuI.ATIoNs ‘ z
, Section 1601.15 of EEOC's regulations provides that persons or. organizations charged with employment
I » discrimination may submit a statement of position or evidence regarding the issues covered by this charge.
EEOC's recordkeeping and reporting requirements are found at Title 29, Code of Federal Regulations (29 CFR):
29 CFR Part 1602 (see particularly Sec. 1602.14 below) for Title Vll and the ADA; 29 CFR Part 1620 for the EPA;
and 29 CFR Part 1627, for the ADEA. These regulations generally require respondents to preserve payroll and
personnel records relevant to a charge of discrimination until disposition of the charge or litigation relating to the
charge. (For ADEA charges, this notice is the written requirement described in Part 1627, Sec. 1627.3(b)(3), if
.4(a)(2) or .5(c), for respondents to. preserve records relevant to the charge - the records to be retained, and for ;§
how long, are as described in Sec. 1602.14, as set out below). Parts 1602, 1620 and 1627 also prescribe record e;
retention periods — generally, three years for basic payroll records and one year for personnel records. J
Questions about retention periods and the types of records to be retained should be resolved by referring to the
regulations. Q
Section 1602.14 Preservation of records made or kept. .... Where a charge has been tiled, or an action
brought by the Commission or the Attorney General, against an employer under Title VII or the ADA, the q
respondent shall preserve all personnel records relevant to the charge or the action until tinal disposition of the
charge or action. The term personnel records relevant to the charge, for example, would include personnel or ,
employment records relating to the aggrieved person and to all other aggrieved employees holding positions gl
similar to that held or sought by the aggrieved person and application forms or test papers completed by an 5
unsuccessful applicant and by all other candidates or the same position as that for which the aggrieved person ,
applied and was rejected. The date of jinal disposition ofthe charge or the action means the date of expiration of
the statutory period within which the aggrievedperson may bring [a lawsuit] or, where anaction is brought . ·
against an employer either by the aggrieved person, the Commission, or the Attorney General, the date on which
such litigation is temtinated. I
NOTICE OF NON-RETALIATION REQUIREMENTS -
Section 704(a) of Title VII, Section 4(d) of the ADEA, and Section 503(a) of the ADA provide that it is an unlawful ifi
employment practice for an employer to discriminate against present or former employees orjob applicants, for
an employment agency to discriminate against any individual, or for a union to discriminate against its members
or applicants for membership, because they have opposed any practice made an unlawful employment practice P;
by the statutes, or because they have made a charge, testified, assisted, or participated in any manner in an é,
investigation, proceeding, or hearing under the statutes. The Equal Pay Act contains similar provisions.
Additionally, Section 503(b) of the ADA prohibits coercion, intimidation, threats, or interference with anyone
t because they have exercised or enjoyed, or aided or encouraged others in their exercise or enjoyment, of rights
under the Act. _
Persons filing charges of discrimination are advised of these Non-Retaliation Requirements and are instructed to ,
notify EEOC if any attempt at retaliation is made. Please note that the Civil Rights Act of 1991 provides {gi
substantial additional monetary provisions to remedy instances of retaliation or other discrimination, including, for
example, to remedy the emotional harm caused by on—the-job harassment. ;
NOTICE REGARDING REPRESENTATION BY ATTORNEYS
Although you do not have to be represented by an attorney while we handle this charge, you have a right, and »
may wish to retain an attorney to represent you. If you do retain an attorney, please give us your attorney's
name, address and phone number, and ask your attorney to write us confirming such representation.
. _ ‘ K00504 lg

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_ r· , · Case 3:O7—cv-031 1 I Document 48f2@’~RGIF10eBP® . 1Féa:ger3ioft4.
V RESPONDENT: Kaiser Foundation Health Plan l
W CHARGE OF DISCRIMINATION SUBMITTED BY FERNANDO M. DAROSA AGAINST .
KAISER FOUNDATION HEALTH PLAN, 3801 HOWE STREET, OAKLAND, CALIFORNLA
94611. —_ I _·-` -· - —-
On or about May 19, 2000, I was hired b_y Kaiser Foundation Health Plan ("Kaiser"), On or
February 3, 2006, I received notice in the mail that Kaiser had temiinated by employment, allegedly fg
for job abandonment. I have worked continuously for Kaiser since May 19, 2000. During calendar
years 2004 and 2005, I worked more than 1250 hours with Kaiser.
For a number of years, I have experienced difficulty staying awake. ln July 2005, I was diagnosed
with narcolepsy. My treating physician has prescribed medicine for me; however, my treating Q;
physician has not determined an effective combination of drugs to relieve my problem with
narcolepsy. In any event, in about July 2005, I told Kaiser of my medical condition, and I asked
Kaiser to lower the room temperature to help me stay awake. Kaiser objected to lowering the room
temperature. Indeed, Kaiser did not offer me an accommodation for my physical condition. {
My treating physician_took me off work in July 2005 until about August 22, 2005; in addition,
‘ my treating physician took me off work because of my serious medical condition intermittently from j-2
September through and including December 2005. I required additional time off work in J anuary ig
I 2006, because of my serious medical condition. On none of these occasions, did Kaiser tell me that
I was eligible for family medical leave. In addition, as a result of being off work to care for my own
serious medical condition, Kaiser terminated my employment, claiming that I-had abandoned my j ob.
I believe that Kaiser terminated my employment because I needed FMLA leave and because
I havephysical disability (narcolepsy). -
I declare under penalty of perjury under the laws of the United States that the forgoing is true and
correct.
Dated: April 3, 2006 ·
g I rernando DaRosa
2 Rrcuvro
APR 1 8 2006
g!9<2a<>t¢>
Complaint.EEOC c:\
_ Konsos .

tsmsumwm EEOGCase 3:07-cv-0311.I Document 48-20 Filed 09/$008 TP?;;e EEFQUQ F Hg
D Ecrm 731 (5/D1) g
INFORMATION ON CHARGES OF DISCRIMINATION T
EEOC Rur.es AND REcur.ATroNs . _ .
. Section 1601.15 of EEOC‘s regulations provides that persons or organizations charged with employment . , y,
discrimination may submit a statement of position or evidence regarding the issues covered by this charge. ji,
~ EEOC‘s recordkeeping and reporting requirements are found at 'litle 29, Code of Federal Regulations (29 CFR):
29 CFR Part 1602 (see particularly Sec. 1602.14 below) for Title Vll and the ADA; 29 CFR Part 1_620 for the EPA;
I and 29 CFR Part 1627, for the ADEA. These regulations generally require respondents to preserve payroll and yl
e personnel records relevant to a charge of discrimination until disposition of the charge or litigation relating to the ji
charge. (For ADEA charges, this notice is the written requirement described in Part1627, Sec. 1627.3(b)(3), .
.4(a)(2) or .5(c), for respondents to preserve records relevant to the charge — the records to be retained, and for
how long, are as described in Sec. 1602.14, as set out below). Parts 1602, 1620 and 1627 also prescribe record
· retention periods - generally, three years for basic payroll records and one year for personnel records. G
-.-.QuestionS.¤b.qut retention .¤eriods_and_the.types oftecords lobe retained should be resolued by. referring to thee.
regulations.
Section 1602.14 Preservation of records made or kept. .... Where a charge has been tiled, or an action g`
brought by the Commission or the Attomey General, against an employer under Title VII or the ADA, the
respondent shall preserve all personnel records relevant to the charge or the action until tinal disposition of the
charge Of action. The tern'! personnel records relevant I0 the charge, for example, would include personnel OT
employment records relating to th aggrieved person and to all other aggrieved employees holding positions Z}
similar to that held or sought by the aggrieved person and application forms or test papers completed by an
unsuccessful applicant and by all other candidates or the same position as that for which the aggrieved person {T2
applied and was rejected. The date of jimi disposiricn ofthe charge or the action means the date of expiration of {L;
the statutory period within which the aggrieved person may bring [a lawsuit] cr, where an action is brought Q,
against an employer either by the aggrieved person, the Commission, or the Attomey General, the date on which
such litigation is temtinated. ·
NOTICE OF NON—RETALIATIDN REQUIREMENTS ,j
Section 704(a) of Title Vll, Section 4(d) ofthe ADEA, and Section 503(a) of the ADA provide that it is an unlawful
employment practice for an employer to discriminate against present or former employees orjob applicants, for Y?
an employment agency to discriminate against any individual, or for a union to discriminate against its members
or applicants for membership, because they have opposed any practice made an unlawful employment practice
by. the. statutes,.or because they have made a charge, testified, assisted, or participated in any manner in an J
investigation, proceeding, or hearing under the statutes. The Equal Pay Act contains similar provisions.
Additionally, Section 503(b) ofthe ADA prohibits coercion, intimidation, threats, or interference with anyone
because they have exercised or enjoyed, or aided or encouraged others in their exercise or enjoyment, of rights =Â¥j
under the Act. '
Persons tiling charges of discrimination are advised of these Non-Retaliation Requirements and are instructed to ile
notify EEOC if any attempt at retaliation is made. Please note that the Civil Rights Act of 1991 provides —
substantial additional monetary provisions to remedy instances of retaliation or other discrimination, including, for
example, to remedy the emotional harm caused by on-the-job harassment.
NOTICE REGARDING REPRESENTATION BY ATTORNEYS ?
I Although you do not have to be represented by an attorney while we handle this charge, you have a right, and Y`
may wish to retain an attorney to represent you. If you do retain an attorney, please give us your attorney's ri
name, address and phone number, and ask your attomey to write us confirming such representation. ei
. K00s06 jj

Case 3:07-cv-03114-SI

Document 48-20

Filed 09/05/2008

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