Nevada > County > Clark > Justice Court > Las Vegas Township > Workplace Harassment
Application For A Temporary Order Against Harassment In The Workplace - Nevada
| Application For A Temporary Order Against Harassment In The Workplace Form. This is a Nevada form and can be used in Workplace Harassment Las Vegas Township Justice Court Clark County . |
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JUSTICE COURT, LAS VEGAS TOWNSHIP CLARK COUNTY, NEVADA __________________________________, ) ) Plaintiff ) (Employer or authorized ) agent of employer) ) ) vs. ) __________________________________, ) Defendant. ) (NOTE: The request must be ) limited to one defendant ) only.) ) ____________________________________) IN THE MATTER OF THE APPLICATION FOR A TEMPORARY ORDER FOR PROTECTION AGAINST HARASSMENT IN THE WORKPLACE Case No.____________________________ (To be completed by court staff) AFFIDAVIT The above named Plaintiff(s), being first duly sworn, deposes and says: The Defendant named above has committed an act or acts constituting harassment in the workplace. NAME OF POLICE DEPARTMENT AND REPORT NUMBER WHERE A COMPLAINT ABOUT THESE ACTS HAS BEEN FILED (IF APPLICABLE): ____________________________________________________________________________ The relevant information about my workplace is as follows: BUSINESS NAME: ADDRESS: ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ The relevant information about the defendant is as follows: NAME: ADDRESS (if known): _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ 1 American LegalNet, Inc. www.USCourtForms.com The acts occurred as follows: (Be specific as to the alleged acts of the defendant, the identity of all relevant parties, all important dates and locations, etc. Also, please make sure that the information you provide is LEGIBLE.) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ *PLEASE ATTACH ADDITIONAL SHEET(S) IF MORE SPACE IS NEEDED. Provisions Relating to Notice (Please check the appropriate box.) 9 The Defendant has been given advance notice about this Application for a Temporary Order, based on the following: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ The Defendant has not been given advance notice about this Application for a Temporary Order. If this box is checked, you must fill out and submit an additional form from the court. This form is entitled ASupplemental Affidavit Relating to Lack of Notice to the Defendant.@ I, therefore, request that a Temporary Order for Protection against Harassment in the Workplace 2 American LegalNet, Inc. www.USCourtForms.com 9 be issued against the Defendant so that the Defendant will be enjoined from contacting my business and/or its employees and/or any person present at the workplace, and so that the Defendant will be ordered to stay away from my workplace. I also request that the Court prohibit the Defendant from violating this Order via e-mail, correspondence, telephone, or agent. Under the penalty of perjury, I (Applicant) swear or affirm that the above information is true and that the requested Temporary Order for Protection Against Harassment in the Workplace should be granted. Plaintiff=s Signature __________________________________________ PLEASE COMPLETE SECTION 1 OR 2 BELOW: (1) NOTARY: Signed and Sworn to or Affirmed Before Me This _______ day of ______________, 20_____. Notary Public______________________________ (2) UNSWORN DECLARATION (Per NRS 53.045): (a) If executed in this state: "I declare under penalty of perjury that the foregoing is true and correct." Executed on ___________________ (Date) (b) If executed outside this state: "I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct." Executed on ___________________ (Date) ___________________________________ (Signature) ___________________________________ (Signature) PLEASE STAMP BELOW: 3 American LegalNet, Inc. www.USCourtForms.com
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