UNITED STATES DISTRICT COURT WESTERN DISTRICT OF MISSOURI
Plaintiff vs. (1)
(2)
(3) Defendant(s)
) ) ) ) ) ) ) ) ) ) ) )
Case No.
COMPLAINT TITLE VII
Comes now plaintiff,
and for his/her claim against the defendant(s) states and alleges as follows:
1. This action is brought and jurisdiction lies pursuant to 42 U.S.C. Section 2000e.5. Venue is proper in this district;
2. Plaintiff is a
race sex
who resides at
street address
city
state
zip
3. The defendant (1)
is an employer, employment agency, or labor
organization, as defined in 42 U.S.C. Section 2000e, and is located at
Address
1
NOTE: USE THIS PAGE ONLY IF THERE IS MORE THAN ONE DEFENDANT
3a. The defendant (2)
is an employer, employment agency, or labor
organization, as defined in 42 U.S.C. Section 2000e, and is located at
Address
3b. The defendant (3)
is an employer, employment agency, or labor
organization, as defined in 42 U.S.C. Section 2000e, and is located at
Address
3c. The defendant (4)
is an employer, employment agency, or labor
organization, as defined in 42 U.S.C. Section 2000e, and is located at
Address
3d. The defendant (5)
is an employer, employment agency, or labor
organization, as defined in 42 U.S.C. Section 2000e, and is located at
Address
3e. The defendant (6)
is an employer, employment agency, or labor
organization, as defined in 42 U.S.C. Section 2000e, and is located at
Address
2
4. On or about
, 20
, defendant(s) (Specify the unlawful employment,
practice which you are alleging against the defendant(s), such as: Refusal to hire, discharge from employment harassment in
because of (state why defendant[s] discriminated against you, i.e., race, color, religion, sex, or national origin, etc.)
5.
Plaintiff timely filed a written complaint of discrimination with the Equal Employment
Opportunity Commission and received a right-to-sue letter, a copy of which is attached. All conditions precedent to the institution of this lawsuit have been fulfilled. WHEREFORE, plaintiff prays for (state what relief is sought):
and such other relief as the court would allow under Title VII of the Civil Rights Act of 1964.
Signature
Street Address
City
State
Zip Code
Telephone
:titlevii.int
3