New Jersey > Statewide > Miscellaneous
Equal Employment Opportunity Discrimination Complaint Form - New Jersey
| Equal Employment Opportunity Discrimination Complaint Form Form. This is a New Jersey form and can be used in Miscellaneous Statewide . |
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COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. JUDICIARY OF THE STATE OF NEW JERSEY : Calendar No. Formal Discrimination / Sexual Harassment / Retaliation Complaint Form: Plaintiff(s) -against: Complainant Information Name Address Phone Job Title Last Name First Name JUDICIAL SUBPOENA Date Filed : Middle Name : Number and Street City State Zip Defendant(s) : ...................................................... Home Phone Work Phone Vicinage / Division /AOC THE PEOPLE OF THE STATE OF NEW YORK Complainant Status (Check applicable box) TO Judicial Employee Volunteer Other If you checked "other," specify whether: Job Applicant Probationer Vendor GREETINGS: Other (Litigant, witness, etc.)_______________________ (specify) Name and Title of Person(s) You Believe Discriminated Against You: Name Name Name WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Job Title , the Honorable at the Court Vicinage / Division / AOC located at County of Job Title Vicinage / Division / AOC in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give Title Job evidence as a witness in this action on the part/ Division / AOC Vicinage of the Basis of Complaint (Check applicable box or boxes) Race Disability / Perceived Disability Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Color National Origin/Nationality Ancestry Age Marital Status Sex/Gender the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Atypical Hereditary Cellular or Blood Trait Sexual or Affectional Orientation Veteran Status or Liability for Military Service Religion/Creed Witness, Honorable Court in County, day of , Submit Domestic Partnership Status Use of Genetic Information, including Refusal to20 to or Provide Results of Genetic Test , one of the Justices of the Sexual Harassment Retaliation Description of Complaint - List each incident separately and describe in detail the incident(s) and time and place of occurrence. NOTE: A copy of this (Attorney must sign above and type or background form will be provided to the person(s) against whom you are filing a complaint. Therefore you should not identify witnessesname below) evidence on this form. You will be asked to submit that material separately to the investigator who will investigate your complaint. Description of Incident: Attorney(s) for Date of Incident Was incident reported to anyone? If yes, who? Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: Date Reported American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. Description of Incident: : : Plaintiff(s) -against: : Index No. Calendar No. Date of Incident Was incident reported to anyone? If yes, who? JUDICIAL SUBPOENA Date Reported : Description of Incident: : Date of Incident Defendant(s) : ...................................................... Was incident reported to anyone? If yes, who? THE PEOPLE OF THE STATE OF NEW YORK Date Reported TO Description of Incident: Date of Incident GREETINGS: Was incident reported to anyone? If yes, who? WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon,Date Reported recessed and at any or adjourned date, to testify and give evidence as a witness in this action on the part of the Remedy Sought (Explanation) Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Additional pages may be attached.) Note: The Complainant has a right to use the external procedures available under state law (Division on Civil Rights) and federal law (Equal Employment Opportunity Commission). Information regarding external procedures is contained in the Policy Statement and on posters located in the Human Resources Office. (Attorney must sign above and type name below) Date Local EEO/AA Officer/Regional Investigator Signature / / Complainant=s Signature Attorney(s) for Date The completed form is to be given to the local EEO/AA Officer or to the Chief Judiciary EEO/AA officer in the AOC. Office and P.O. Address 46 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com
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