Pro Se 7 (Rev. 12/16) Complaint for Employment Discrimination United States District Court for the District of Division Case No. ) ) (to be filled in by the Clerk’s Office) ) ) Plaintiff(s) ) (Write the full name of each plaintiff who is filing this complaint. Jury Trial: Yes No If the names of all the plaintiffs cannot fit in the space above, (check one) ) please write "see attached" in the space and attach an additional ) page with the full list of names.) -v- ) ) ) ) ) Defendant(s) (Write the full name of each defendant who is being sued. If the ) names of all the defendants cannot fit in the space above, please ) write “see attached” in the space and attach an additional page ) with the full list of names.) COMPLAINT FOR EMPLOYMENT DISCRIMINATION I. The Parties to This Complaint A. The Plaintiff(s) Provide the information below for each plaintiff named in the complaint. Attach additional pages if needed. Name Street Address City and County State and Zip Code Telephone Number E-mail Address B. The Defendant(s) Provide the information for each defendant named in the complaint, whether the defendant is an individual, a government agency, an organization, or a corporation. For an individual defendant, include the person’s job or title Attach additional pages if needed. (if known). Defendant No. 1
Pro Se 7 (Rev. 12/16) Complaint for Employment Discrimination United States District Court for the District of Division ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) Case No. (to be filled in by the Clerk’s Office) Plaintiff(s) (Write the full name of each plaintiff who is filing this complaint. If the names of all the plaintiffs cannot fit in the space above, please write "see attached" in the space and attach an additional page with the full list of names.) -v- Jury Trial: (check one) Yes No Defendant(s) (Write the full name of each defendant who is being sued. If the names of all the defendants cannot fit in the space above, please write “see attached” in the space and attach an additional page with the full list of names.) COMPLAINT FOR EMPLOYMENT DISCRIMINATION I. The Parties to This Complaint A. The Plaintiff(s) Provide the information below for each plaintiff named in the complaint. Attach additional pages if needed. Name Street Address City and County State and Zip Code Telephone Number E-mail Address B. The Defendant(s) Provide the information for each defendant named in the complaint, whether the defendant is an individual, a government agency, an organization, or a corporation. For an individual defendant, include the person’s job or title (if known). Attach additional pages if needed. Defendant No. 1
complaint_for_employment_discrimination.docx