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Instructions for Completing Your Statement of Discrimination:

Write a short, clear statement explaining how the Respondent (employer, agency, or union) discriminated

against you. You cannot name more than one Respondent per complaint form. When writing your statement,

please include the following:

a) Give your job title and date of hire. If the company did not hire you, state the job(s) you applied for and

the date you applied.

b) Describe what happened that you think was discrimination. If you were harassed, identify the

harasser(s) and describe what was done to you. If you complained to the company, identify the

person(s) you complained to and describe the company response to your complaint(s). Include the

date(s), if known. If you were fired or were forced to quit due to a discriminatory reason make this clear

in your statement.

c) For each box you checked, in section #3, explain why you think the employer’s actions to you were

motivated by the action checked. If you checked the ‘disability’ box you must identify the medical name

of your disability. If you checked the ‘I opposed discrimination in the workplace’ box you must explain

how your employer retaliated against you for making an internal complaint about discrimination based

on any of the boxes in section #3. Retaliation because you complain about anything not connected to a

box is not addressed by discrimination law.

d) If other employees in similar situations were treated better than you were, please give their names,

state what happened to them and describe how they differ from you in terms of the box(es) you

checked in section #3.

e) If you need more space, please continue your statement on a separate piece of paper.

f) Do not use whiteout to make corrections. Draw a line through errors and initial each change.

g) You will have a chance to give the investigator more information during the investigation of your

complaint. If you send supporting documents with your complaint do not refer to them in your

statement.

If you have questions or if you need help completing this form, please call the Equal Rights Division at (414)

227-4380 (Milwaukee) or (608) 266-6860 (Madison) and ask to speak to a Civil Rights Investigator. We can

help you complete the form.

For violations in Milwaukee, Waukesha, Ozaukee, Washington, Kenosha, Racine, Sheboygan and

Walworth Counties, mail your completed and signed complaint to:

EQUAL RIGHTS DIVISION

819 N 6

ST ROOM 255

MILWAUKEE WI 53203

For all other counties in Wisconsin:

EQUAL RIGHTS DIVISION

PO BOX 8928

MADISON WI 53708

Website:

Erd Case - Discrimination Complaint Wisconsin Fair Employment Law. Equal Rights Complaint Process Information Sheet Page 2