INSTRUCTIONS FOR FILING A LAWSUIT

UNDER THE CIVIL RIGHTS ACT OF 1964 (EEOC 42:2000)
This is in response to your inquiry about a lawsuit you may wish to bring under Title VII of
the Civil Rights Act of 1964. Under this law the Court is, upon application by a complainant, permitted to appoint an attorney for the applicant and to allow commencement of the action without prepayment of fees, costs or security.
Any such application is, at the direction of this Court, to be in writing and to be filed with
this office. Forms for these applications are available upon request or on our website (www.lawd.uscourts.gov).
You are cautioned that any lawsuit under Title VII to be brought by you or on your behalf
must be filed within 90 days after receipt by you of the EEOC's "right-to-sue" notice. A delay on your part in filing an application for appointment of an attorney or waiver of prepayment of fees may result in loss of rights under Title VII.
The clerk will automatically refer any motions you submit in connection with your complaint
to the appropriate judge or magistrate judge, and will promptly send you copies of any orders signed in response to your motions. If your case is allowed to be filed, the order will reflect a Civil Action number which you should provide with all future inquiries and pleadings.
If you need additional copies of this application form or further information, please advise
this office.
Very truly yours,
TONY R. MOORE

Clerk of Court

300 Fannin Street, Suite 1167

Shreveport, LA 71101-1167

318-676-4273

UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF LOUISIANA
DIVISION
Civil Action No.
Plaintiff
VS.	Judge
Magistrate Judge
Defendant
COMPLAINT

UNDER SECTION 706 (f) OF THE CIVIL RIGHTS ACT OF 1964

A.	Describe in your own words the employment practices about which you are complaining,
identifying the persons, firms, companies, unions, agencies or bodies you say have engaged in such practices. Attach an additional sheet, if necessary.
B.	Have you filed with the Equal Employment Opportunity Commission (EEOC) a charge
relating to such practices?	Yes	No
C.	Have you received from the EEOC a letter notifying you of your "right-to-sue" respecting
such charges?	Yes	No
If "Yes," attach a copy of such letter and notice, and state when you received same.
Date received:
D.	Have you received from the EEOC a copy of its determination with regard to your charges?
Yes	No
If "Yes," attach a copy of such determination. Also, if you disagree with any of the EEOC's
findings or conclusions, state why:
E.	Give any other information you desire to disclose which supports your claim of
discriminatory employment practices.
F.	Under penalty of perjury, I declare that the information given in this complaint is true and
correct.
Date:

(Signature)
(Street Address or P.O. Box)
(Witness)	(City, State, Zip Code)
-
(Witness)	(Area Code)	(Telephone Number)