Indiana > Federal > District Court > Southern District
Employment Discrimination Complaint - Indiana
| Employment Discrimination Complaint Form. This is a Indiana form and can be used in Southern District District Court Federal . |
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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; American LegalNet, Inc. www.FormsWorkFlow.com _______ 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 American LegalNet, Inc. www.FormsWorkFlow.com 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) American LegalNet, Inc. www.FormsWorkFlow.com
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