Fillable Form Sd03 - Claim Form printable pdf download

Form Sd03 - Claim Form

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SD03 (Rev. 9/97)

IN THE UNITED STATES DISTRICT COURT

FOR THE SOUTHERN DISTRICT OF OHIO

_____________________________

(Enter above the full name of the plaintiff in this

action)

Case No. ___________________

_____________________________

COMPLAINT UNDER

42 U.S.C. 2000e-5(f)(1)

_____________________________

(Enter the above full name of the defendant or

defendants in this action)

Parties

(In item A below, place your name in the first blank and place your present address and telephone

number (or telephone number where you can be reached) where indicated in the following blanks.)

Name of Plaintiff ___________________________________________________

Address __________________________________________________________

Telephone No. _____________________________________________________

Under 42 U.S.C. 2000e-5(f)(1) suit may only be “brought against the respondent named in the

charge” of unlawful employment practice you filed with the Ohio Civil Rights Commission and/or

the Equal Employment Opportunity Commission. ATTACH A COPY OF THE CHARGE YOU

FILED WITH THE OHIO CIVIL RIGHTS COMMISSION AND/OR THE EQUAL

EMPLOYMENT OPPORTUNITY COMMISSION TO THIS COMPLAINT. In item B below list

the name and address of the employer against whom you filed the charge. In item C below, list the

name and address of any other person(s) you named in the charge you filed with the Ohio Civil

Rights Commission and/or the Equal Employment Opportunities Commission.

Defendant _________________________________________________________

(As named in the attached charge)

Address __________________________________________________________

__________________________________________________________

-1-

Form Sd03 - Claim Form

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