Erd Case - Discrimination Complaint Wisconsin Fair Employment Law. Equal Rights Complaint Process Information Sheet Page 3

5. Statement of discrimination:

Write a brief, concise statement explaining how you were discriminated against. Give the date each action

occurred and the name of the person who took the action. Explain how each action(s) was related to the

box (es) you checked in section #3 on page one.

6. Certification and Signature

By my signature below, I certify that I have read the above complaint, and, under penalties of law, I declare

that this complaint is true and correct to the best of my knowledge and belief.

Signature of Complainant or authorized representative

Date signed

Please complete Equal Rights Process Information Sheet on Page 4

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