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UNITED STATES DISTRICT COURT EASTERN DISTRICT OF ARKANSAS DIVISION (Name of plaintiff or plaintiffs) v. CIVIL ACTION NO. (case number to be supplied by the assignment clerk) (Name of defendant or defendants) COMPLAINT UNDER TITLE VII OF THE CIVIL RIGHTS ACT OF 1964 1. This action is brought pursuant to Title VII of the Civil Rights Act of 1964 for employment discrimination. Jurisdiction is specifically conferred on the Court by 42 U.S.C. §2000e-5. Equitable and other relief are also sought under 42 U.S.C. §2000e-5(g). 2.Plaintiff, , is a (name of plaintiff) citizen of the United States and resides at , (street address) , , , , (city) (county) (state) (ZIP) . (telephone) 3.Defendant, , lives at, or its (name of defendant) business is located at , , (street address) (city) , , . (county) (state)(ZIP) 4.Plaintiff sought employment from the defendant or was employed by the defendant at , , (street address) (city) , , . (county) (state)(ZIP) 5.Defendant discriminated against plaintiff in the manner indicated in paragraphs 9 and 10 of the complaint on or about . (day) (month)(year) 6.Plaintiff filed charges against the defendant with the Equal Employment Opportunity Commission charging defendant with the acts of discrimination indicated in paragraphs 9 and 10 of this complaint on or about . (day)(month) (year) 7.The Equal Employment Opportunity Commission issued a Notice of Right to Sue which was received by plaintiff on , a copy of which notice (day)(month) (year) is attached to this complaint. 8.Because of plaintiff s (1) race, (2) color, (3) sex, (4) religion, (5) national origin, defendant: (a) failed to employ plaintiff. (b) terminated plaintiff s employment. (c) failed to promote plaintiff. (d) 9.The circumstances under which the defendant discriminated against plaintiff were as follows: 10.The acts set forth in paragraph 9 of this complaint: (a) are still being committed by defendant. (b) are no longer being committed by defendant. (c) may still be being committed by defendant. 11. Plaintiff attaches to this complaint a copy of the charges filed with the Equal Employment Opportunity Commission which charges are submitted as a brief statement of the facts supporting this complaint. WHEREFORE, plaintiff prays that the Court grant the following relief to the plaintiff: (a) Defendant be directed to employ plaintiff, and (b) Defendant be directed to re-employ plaintiff, and (c) Defendant be directed to promote plaintiff, and (d) Defendant be directed to and that the Court grant such relief as may be appropriate, including injunctive orders, damages, costs and attorney s fees. SIGNATURE OF PLAINTIFF