Can this petition be e‑signed and filed electronically?

Yes in most cases. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted; verify the receiving agency’s e‑submission rules and consent requirements before filing.

What deadlines apply to filing a discrimination claim?

Federal administrative charge deadlines are typically 180 days from the act, extended to 300 days when state law applies. Some state agencies set different limits—confirm the applicable statute or agency guidance before filing.

Which supporting documents are essential to attach?

Attach correspondence, performance records, payroll or scheduling evidence, witness contact details, and any relevant medical releases. Redact or obtain authorizations for protected medical information consistent with HIPAA.

Is notarization or witness signature required?

Not usually for administrative charges, but some states or agency forms may require notarization or witness attestations for certain affidavits; consult state filing rules or the agency’s intake instructions.

How can I correct or amend a filed petition?

Submit an amendment or supplemental statement per the agency’s procedure; include the petition number and clearly label new facts. Timely supplementing preserves the record for investigation.

What happens if the agency dismisses the petition?

An agency dismissal may include a right-to-sue letter allowing litigation in federal court. Review the dismissal rationale and consult counsel promptly about appeal or lawsuit deadlines.

Electronic Signature
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Petition to Remedy Discrimination

Petition to Remedy Discrimination

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

PETITION TO REMEDY DISCRIMINATION

STATE OF MAINE

WORKERS' COMPENSATION BOARD

27 STATE HOUSE STATION

AUGUSTA, MAINE 04333-0027

EMPLOYEE

NAME:

STREET/P.O. BOX:

CITY, STATE, ZIP:

TELEPHONE NUMBER:

DATE OF BIRTH:

SOCIAL SECURITY NUMBER: XXX-XX-

(only last four digits required)

BOARD FILE NUMBER:

EMPLOYER

NAME:

STREET/P.O. BOX:

CITY, STATE, ZIP:

WORKERS' COMPENSATION INSURER (NOTICE ONLY)

NAME:

STREET/P.O. BOX:

CITY, STATE, ZIP:

1. On alleged a work-related

injury while working for

2. The above-named employer discriminated against the employee for testifying or asserting a claim under Title 39-A in the following ways (explain how the employer discriminated):

THEREFORE, the employee asks the board to order relief pursuant to 39-A M.R.S.A. §353.

SIGNATURE OF PETITIONER

DATED:

NAME OF EMPLOYEE'S ATTORNEY OR ADVOCATE (IF ANY)

STREET/P.O. BOX

CITY, STATE, ZIP

TELEPHONE NUMBER

FILING INSTRUCTIONS

Mail original petition to the Workers' Compensation Board at the above address by regular mail.
Mail one (1) copy by certified mail, return receipt requested to each other party named in the petition.
Keep one (1) copy for yourself and keep the green certified mail cards when returned to the U.S. Post Office.

The State of Maine provides equal opportunity in employment and programs. Auxiliary aids and services are available to individuals with disabilities upon request. For assistance with this form, contact the ADA Coordinator at the Maine Workers' Compensation Board. Telephone: (888) 801-9087 or TTY Maine Relay 711.
WCB-195 (eff. 1/1/13)

What the Petition to Remedy Discrimination Is

A Petition to Remedy Discrimination is a formal written request filed with an administrative agency or court seeking relief for alleged discrimination based on protected characteristics such as race, sex, religion, national origin, disability, age, or other categories under federal or state law. The petition summarizes factual allegations, identifies the legal theories and statutes relied upon, and requests specific remedies such as reinstatement, back pay, injunctive relief, policy change, or damages. It often initiates an enforcement or adjudicative process and may be filed with an employer, a state civil rights agency, or the U.S. Equal Employment Opportunity Commission depending on jurisdiction and claim type.

Why a Clear Petition Matters

A well‑drafted petition preserves claims, establishes a factual and legal record, and makes it possible for decision-makers to assess remedies. It helps secure deadlines, gathers evidence, and frames the scope of relief sought under federal statutes and state fairness laws.

Who Typically Prepares and Files This Petition

Parties and representatives who commonly prepare the petition include affected employees, student claimants, attorneys, union representatives, and civil rights advocates.

Individual claimants and pro se filers seeking administrative relief or filing a civil complaint.
Employment counsel or civil rights attorneys preparing legal arguments and evidence for agency or court review.
Human resources or compliance officers preparing responses or internal remediation plans when filing on an employer's behalf.

The petitioner’s capacity—individual, counsel, or organization—affects required signatures, supporting documentation, and filing route.

Core Elements to Include in a Professional Petition

A complete petition combines factual narrative, statutory basis, relief requested, and procedural details so adjudicators can evaluate jurisdiction and remedies efficiently.

Caption

Case caption or agency heading naming petitioner(s), respondent(s), docket or charge number, and contact details formatted per the receiving agency’s requirements.

Statement of Facts

Chronological, concise narrative of discriminatory acts with dates, locations, the identity of decision-makers, and specific incidents that support each asserted violation.

Legal Claims

Cite the statute or regulation relied upon (for example Title VII, ADA, ADEA, or state civil rights law) and map factual allegations to each legal element.

Remedies Sought

Specify relief sought—back pay, reinstatement, compensatory damages, injunctive relief, policy changes, or training—quantifying amounts where applicable.

Supporting Evidence

List attachments such as correspondence, performance reviews, witness statements, medical records (HIPAA considerations), and payroll data with brief descriptions.

Verification and Signature

Execution block with petitioner signature, date, printed name, and counsel contact information; include notary or witness statements when required by jurisdiction.

Step-by-Step: Preparing and Filing the Petition

Follow these sequential steps to prepare a defensible petition and meet procedural prerequisites for administrative or judicial filing.

01

Gather Evidence: Collect emails, reviews, witness contact details, and payroll history supporting each allegation.
02

Draft Narrative: Write a clear chronological account linking facts to legal elements of the claim.
03

Select Filing Route: Decide between agency charge (EEOC/state agency) or direct court filing based on statute and remedies sought.
04

Execute and Submit: Sign, notarize if required, and file with the correct agency or clerk per local rules.

Typical Filing Flow for a Discrimination Petition

The filing process moves from internal collection through agency intake to investigation or adjudication; understanding each step reduces procedural missteps.

Internal Review: Optional pre-filing attempt to resolve via HR or grievance procedures.
Agency Intake: Agency reviews petition for jurisdictional sufficiency and issues a charge number.
Investigation: Agency gathers evidence, interviews witnesses, and may attempt mediation.
Determination / Litigation: Agency issues finding or right-to-sue; litigant may proceed to court if permitted.

Configuring an Electronic Filing Workflow

Set up fields, routing, and authentication to match the petition’s procedural requirements and the chosen filing channel.

Field	Configuration
Signature Type	E-signature with audit trail
Authentication	Email link or SMS code; consider stronger KBA if required
Routing	Sequential signer flow: petitioner → counsel → notary (if needed)
Retention	Store PDF with audit trail and metadata

Technology Needs for eSubmission

Ensure your chosen platform supports secure signing, audit trails, and exportable PDF/A documents for agency acceptance.

Document Formats: PDF, DOCX accepted
Authentication Methods: Email, SMS, KBA options
Integrations: CRM and cloud storage connectors

Platforms that support TLS/AES encryption, audit trails, and exportable signed PDFs reduce evidentiary risk; verify with the receiving agency whether e-submissions are accepted and what format they require.

Consequences of Filing an Incomplete or Untimely Petition

Statute Bar: Missed filing deadlines can result in dismissal of claims.

Evidentiary Loss: Incomplete documentation weakens proof and remedies.

Procedural Rejection: Nonconforming format or missing fees may lead to administrative rejection.

Privacy Violations: Improper handling of medical records can trigger HIPAA issues.

Identity Mismatch: Name or signature mismatches can delay verification.

Cost Exposure: Unnecessary litigation or remand increases time and fees.

Key Timing Rules to Watch Before Filing

Understanding administrative deadlines preserves legal options; many discrimination claims require prompt agency filing before court action.

EEOC Charge Deadline:

Typically 180 days from the alleged act; extended to 300 days with an applicable state or local law.

State Agency Deadlines:

Some states impose shorter or longer filing periods—confirm with the relevant civil rights agency.

Court Statute of Limitations:

Filing a lawsuit usually follows agency exhaustion and has independent deadlines.

Record Preservation:

Preserve relevant records immediately upon anticipating a claim to prevent spoliation.

Requesting Right-to-Sue:

Obtain an agency right-to-sue letter before pursuing federal court when required.

Common Pitfalls to Avoid When Preparing the Petition

Relying on vague chronology or generalities rather than concrete dates, locations, and actors undermines credibility and makes legal elements hard to prove.
Omitting witness contact information or failing to attach key documentary evidence can prolong investigation and increase the chance of dismissal.
Using informal or conversational language instead of a factual, neutral tone can weaken legal clarity and introduce inadvertent admissions.
Failing to check the receiving agency’s formatting, signature, and filing requirements often leads to administrative rejection or processing delays.

Example Use Cases and Practical Outcomes

These concise examples illustrate typical scenarios where a Petition to Remedy Discrimination is used and the downstream results claimants may seek.

Workplace Discrimination Claim

An employee documents repeated adverse actions tied to protected status and files a petition with the state agency

Petition lists dates, supervisors, and payroll impacts
Agency opens an investigation, mediates, and negotiates back pay and policy change without litigation.

Student Rights Petition

A student alleges discriminatory disciplinary action and compiles performance records and witness statements

Petition requests reinstatement and policy revision
The school conducts an internal review and revises procedures to prevent recurrence.

eSignature Platform Comparison Relevant to Petition Execution

Comparison of typical vendor starting prices and key features for electronic signature workflows used when preparing and submitting petitions; signNow is listed first per table convention.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	Yes, 7-day trial	Yes, trial available	Yes, trial available	Yes, trial available	Yes, limited trial
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Frequently Asked Questions About the Petition

Answers to common procedural and technical questions related to drafting, signing, and filing a Petition to Remedy Discrimination.

Need help? Contact support

Can this petition be e‑signed and filed electronically?
Yes in most cases. Electronic signatures are legally valid under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted; verify the receiving agency’s e‑submission rules and consent requirements before filing.
What deadlines apply to filing a discrimination claim?
Federal administrative charge deadlines are typically 180 days from the act, extended to 300 days when state law applies. Some state agencies set different limits—confirm the applicable statute or agency guidance before filing.
Which supporting documents are essential to attach?
Attach correspondence, performance records, payroll or scheduling evidence, witness contact details, and any relevant medical releases. Redact or obtain authorizations for protected medical information consistent with HIPAA.
Is notarization or witness signature required?
Not usually for administrative charges, but some states or agency forms may require notarization or witness attestations for certain affidavits; consult state filing rules or the agency’s intake instructions.
How can I correct or amend a filed petition?
Submit an amendment or supplemental statement per the agency’s procedure; include the petition number and clearly label new facts. Timely supplementing preserves the record for investigation.
What happens if the agency dismisses the petition?
An agency dismissal may include a right-to-sue letter allowing litigation in federal court. Review the dismissal rationale and consult counsel promptly about appeal or lawsuit deadlines.

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