EEOC Complaint

IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF ALABAMA : Plaintiff, vs. : : : : Defendant(s) : Civil Action No. COMPLAINT 1. 2. 3. Plaintiff resides at Name(s) of defendant(s) Location of principal office(s) of the named defendant(s) 4. Nature of business of defendant(s) 5. 6. Approximate number of individuals employed by defendant(s) The acts complained of in this suit concern: (A) (B) (C) (D) Failure to employ me. Termination of my employment. Failure to promote me. Other acts as specified below: ________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 7. Plaintiff is: (A) (B) Presently employed by the defendant. Not presently employed by the defendant. The dates of employment were _______________________________________ (1) (2) (3) Plaintiff was discharged. Plaintiff was laid off. Plaintiff left the job voluntarily. 8. Defendant(s) discriminated against me on account of my: (A) Race Color Religion Therefore, I am bringing this action for employment discrimination pursuant to Title VII Sex National Origin of the Civil Rights Act of 1964, specifically, 42 U.S.C. § 2000e-5. (B) Physical disability Mental disability Therefore, I am bringing this action pursuant to the American with Disabilities Act, specifically, 42 U.S.C. § 12117. (C) Age Therefore, I am bringing this action pursuant to the Age Discrimination in Employment Act of 1967, specifically, 29 U.S.C. § 626. 9. 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) _________________________________________________________________________ 10. 11. The alleged discrimination occurred on or about The nature of my complaint, i.e., the manner in which the individual(s) named above American LegalNet, Inc. www.FormsWorkFlow.com discriminated against me in terms of the conditions of my employment, is as follows: ________ 12. The alleged illegal activity took place at 13. I filed charges with the Equal Employment Opportunity Commission regarding alleged discriminatory conduct by defendant(s) on or about I have attached a copy of the Notice-of-Right-to-Sue letter issued by the Equal Employment Opportunity Commission. This letter was received by me on 14. 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 attorney's fees. Date: Signature of Plaintiff Address of Plaintiff ( ) Telephone Number of Plaintiff American LegalNet, Inc. www.FormsWorkFlow.com