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The DFEH 300 03 form serves a crucial function for individuals who believe they have experienced discrimination in their employment. This form is an official complaint filed under the California Fair Employment and Housing Act (FEHA), allowing individuals to detail their allegations against employers or other parties involved. It requires personal information such as your name, contact details, and specifics about the alleged discrimination, including the nature of the incident and the reasons behind it. Important aspects of the form include the identification of the employer or organization involved, the dates of the alleged discriminatory acts, and a thorough explanation of the events that transpired. The form also addresses various categories of discrimination, including those based on sex, race, age, disability, and more. Once completed, the DFEH 300 03 allows the complainant to request a right-to-sue notice if they wish to take their case to court. Filing this form correctly is essential, as it sets the stage for any legal proceedings or investigations that may follow.

Dfeh 300 03 Example

* * * EMPLOYMENT * * *

COMPLAINT OF DISCRIMINATION UNDER

DFEH #

THE PROVISIONS OF THE CALIFORNIA

 

FAIR EMPLOYMENT AND HOUSING ACT

 

DFEH USE ONLY

CALIFORNIA DEPARTMENT OF FAIR EMPLOYMENT AND HOUSING

YOUR NAME (indicate Mr. or Ms.)

 

TELEPHONE NUMBER (INCLUDE AREA CODE)

 

 

 

ADDRESS

 

 

 

 

 

CITY/STATE/ZIP

COUNTY

COUNTY CODE

NAMED IS THE EMPLOYER, PERSON, LABOR ORGANIZATION, EMPLOYMENT AGENCY, APPRENTICESHIP COMMITTEE, OR STATE OR LOCAL GOVERNMENT AGENCY WHO DISCRIMINATED AGAINST ME:

NAME

 

 

TELEPHONE NUMBER (Include Area Code)

 

 

 

 

 

 

 

 

ADDRESS

 

 

 

DFEH USE ONLY

 

 

 

 

 

 

 

CITY/STATE/ZIP

 

COUNTY

 

COUNTY CODE

 

 

 

 

 

 

 

NO. OF EMPLOYEES/MEMBERS (if known)

DATE MOST RECENT OR CONTINUING DISCRIMINATION

 

 

RESPONDENT CODE

 

 

 

TOOK PLACE (month, day, and year)

 

 

 

 

THE PARTICULARS ARE:

I allege that on

 

, the

_____ termination

_____ denial of employment

_____ denial of family or medical leave

_____ lay-off

_____ denial of promotion

_____ denial of pregnancy leave

following conduct occurred:

 

 

_____ demotion

_____ denial of transfer

_____ denial of equal pay

 

 

 

 

 

 

_____ harassment

_____ denial of accommodation

_____ denial of right to wear pants

 

 

 

_____ genetic characteristics testing

_____ failure to prevent discrimination or retaliation

_____ denial of pregnancy accommodation

 

 

 

_____ constructive discharge (forced to quit)

_____ retaliation

 

 

 

 

_____ impermissible non-job-related inquiry

_____ other (specify) ____________________________________________

by

because of:

Name of Person

 

Job Title (supervisor/manager/personnel director/etc.)

_____ sex

_____ national origin/ancestry

_____ disability (physical or mental)

_____ retaliation for engaging in protected

_____ age

_____ marital status

_____ medical condition (cancer

activity or requesting a protected

_____ religion

_____ sexual orientation

or genetic characteristic)

leave or accommodation

_____ race/color

_____ association

_____ other (specify) ______________________________________________________

State what you believe to be the reason(s) for discrimination

I wish to pursue this matter in court. I hereby request that the Department of Fair Employment and Housing provide a right-to-sue notice. I understand that if I want a federal notice of right-to-sue, I must visit the U.S. Equal Employment Opportunity Commission (EEOC) to file a complaint within 30 days of receipt of the DFEH "Notice of Case Closure," or within 300 days of the alleged discriminatory act, whichever is earlier.

I have not been coerced into making this request, nor do I make it based on fear of retaliation if I do not do so. I understand it is the Department of Fair Employment and Housing's policy to not process or reopen a complaint once the complaint has been closed on the basis of "Complainant Elected Court Action."

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct of my own knowledge except as to matters stated on my information and belief, and as to those matters I believe it to be true.

Dated

At

City

DATE FILED:

DFEH-300-03 (04/08)

DEPARTMENT OF FAIR EMPLOYMENT AND HOUSING

COMPLAINANT'S SIGNATURE

STATE OF CALIFORNIA

RIGHT-TO-SUE COMPLAINT INFORMATION SHEET

DFEH needs a separate signed complaint for each employer, person, labor organization, employment agency, apprenticeship committee, state or local government agency you wish to file against. If you are filing against both a company and an individual(s), please complete separate complaint forms naming the company or an individual in the appropriate area.

Please complete the following so that DFEH can process your complaint and for DFEH for statistical purposes, and return with your signed complaint(s):

YOUR RACE:/ETHNICITY (Check one)

__ African-American __ African - Other

__ Asian/Pacific Islander (specify)___________

__ Caucasian (Non-Hispanic) __ Native American

__ Hispanic(specify)____________________

YOUR PRIMARY LANGUAGE (specify)

_______________________________________

YOUR AGE: __ __

IF FILING BECAUSE OF YOUR NATIONAL ORIGIN/ANCESTRY, YOUR NATIONAL ORIGIN/ANCESTRY (specify)

_______________________________________

IF FILING BECAUSE OF DISABILITY,

YOUR DISABILITY:

__ AIDS

__ Blood/Circulation

__ Brain/Nerves/Muscles

__ Digestive/Urinary/Reproduction __ Hearing

__ Heart

__ Limbs (Arms/Legs) __ Mental

__ Sight

__ Speech/Respiratory __ Spinal/Back

IF FILING BECAUSE OF MARITAL STATUS,

YOUR MARITAL STATUS: (Check one)

__ Cohabitation __ Divorced __ Married __ Single

IF FILING BECAUSE OF RELIGION,

YOUR RELIGION: (specify)

____________________________________

IF FILING BECAUSE OF SEX, THE REASON: __ Harassment

__ Orientation __ Pregnancy

__ Denied Right to Wear Pants

__ Other Allegations (List) ________________________

DFEH-300-03-1 (04/08)

Department of Fair Employment and Housing

State of California

YOUR GENDER: __ Female __ Male

YOUR OCCUPATION: __ Clerical

__ Craft

__ Equipment Operator __ Laborer

__ Manager

__ Paraprofessional __ Professional __ Sales

__ Service __ Supervisor __ Technician

HOW YOU HEARD ABOUT DFEH: __ Attorney

__ Bus/BART Advertisement __ Community Organization __ EEOC

__ EDD __ Friend

__ Human Relations Commission __ Labor Standards Enforcement __ Local Government Agency __ Poster

__ Prior Contact with DFEH __ Radio

__ Telephone Book __ TV

__ DFEH Web Site

DO YOU HAVE AN ATTORNEY WHO HAS AGREED TO REPRESENT YOU ON YOUR EMPLOYMENT DISCRIMINATION CLAIMS IN COURT? IF YOU CHECK “YES”, YOU WILL BE RESPONSIBLE FOR HAVING YOUR ATTORNEY SERVE THIS DFEH COMPLAINT.

__ Yes

__ No

PLEASE PROVIDE YOUR ATTORNEY’S NAME, ADDRESS AND PHONE NUMBER:

_______________________________________

_______________________________________

_______________________________________

Your Signature

Date

Form Characteristics

Fact Name Description
Governing Laws The DFEH 300 03 form is governed by the California Fair Employment and Housing Act (FEHA). This law prohibits discrimination in employment on various bases.
Purpose The form is used to file a formal complaint of discrimination against an employer or entity covered under FEHA.
Filing Requirements Each complaint must be submitted separately for each respondent, such as employers or individuals who discriminated. Multiple complaints cannot be consolidated into one form.
Right-to-Sue Notice Complainants can request a right-to-sue notice from the DFEH which is necessary if they decide to pursue legal action in court.
Time Limits Filing must occur within 300 days of the alleged discrimination date. A right-to-sue notice is also valid for 30 days after receipt.
Signature Requirement The form requires a declaration under penalty of perjury, emphasizing the seriousness and legality of the complaint being made.

Guidelines on Utilizing Dfeh 300 03

Filling out the DFEH 300 03 form is an important step for individuals who believe they have experienced discrimination in the workplace. Completing the form accurately and thoroughly ensures that the California Department of Fair Employment and Housing (DFEH) can process your complaint effectively. Below are step-by-step instructions to guide you in filling out the form.

  1. Personal Information: Write your full name, including a title (Mr. or Ms.), your telephone number with area code, and your complete address including city, state, and ZIP code.
  2. County Information: Indicate the county where you reside and the county code if known.
  3. Respondent Information: Fill in the name of the employer or individual you are filing a complaint against, along with their telephone number, address, city, state, ZIP code, and county code.
  4. Employee Count: If known, enter the number of employees or members of the organization you are complaining about.
  5. Date of Discrimination: Specify the date of the most recent or continuing discriminatory act using the format month, day, and year.
  6. Details of the Complaint: Check all that apply regarding the particular discrimination you experienced, such as termination, denial of employment, or harassment. You may also add other relevant information in the specified area.
  7. Reason for Discrimination: Identify the characteristics based on which you believe discrimination occurred, such as sex, race, age, or disability. Provide the name and job title of the individual who you believe discriminated against you.
  8. Explanation: State the reasons you believe discrimination occurred. This can include specific incidents or actions.
  9. Right-to-Sue Terminology: Indicate your wish to pursue this matter in court and request a right-to-sue notice from DFEH.
  10. Declaration: Sign and date the form, declaring that the information provided is true to the best of your knowledge and belief.
  11. Right-to-Sue Information Sheet: Complete additional demographic information including race, primary language, age, disability, marital status, and gender. This section helps DFEH for statistical purposes.
  12. Attorney Information: If you have an attorney who will represent you, provide their name, address, and phone number.

After filling out the form, review all entries for accuracy before submitting it. Ensure you keep a copy for your records. The DFEH will process your complaint once you have submitted it with all required information.

What You Should Know About This Form

What is the DFEH 300 03 form used for?

The DFEH 300 03 form is a formal complaint used to report allegations of discrimination related to employment. Under California law, specifically the Fair Employment and Housing Act, individuals who believe they have been subjected to unfair treatment due to specific protected characteristics can file this form. The information provided helps the Department of Fair Employment and Housing (DFEH) to process the complaint and investigate the situation accordingly.

Who can file a complaint using the DFEH 300 03 form?

Any individual who believes they have experienced employment discrimination based on protected characteristics such as race, gender, age, disability, or religious beliefs can file the DFEH 300 03 form. This includes employees, job applicants, and those who have been subject to retaliation for engaging in protected activities. The form is a tool for fighting discrimination and seeking justice under California law.

What information is required on the DFEH 300 03 form?

When completing the DFEH 300 03 form, you will need to provide personal details such as your name, address, and contact information. Additionally, specific information about the employer or individual being complained against is necessary, including their name and address. You will also be asked to describe the nature of the discriminatory conduct and the protected characteristics you believe contributed to the unfair treatment.

What happens after I submit the DFEH 300 03 form?

Once the DFEH receives your completed form, they will review the information provided. If they find sufficient basis to proceed, the DFEH will conduct an investigation into your claims. It is important to note that this process may take some time, as the agency aims to gather all relevant evidence and testimonies. If they find no probable cause, they will issue a “Notice of Case Closure”, which you can use to seek a right-to-sue notice if you wish to pursue your case in court.

How does the DFEH's investigation process work?

The DFEH's investigation process involves various steps, including collecting information from both parties. This may include documentation, witness statements, and other evidence relevant to your claim. After its investigation, if the DFEH finds sufficient evidence of discrimination, they may attempt to mediate a resolution. If mediation fails, they might proceed with initiating litigation on behalf of the complainant if applicable.

Can I pursue my case in court after filing the DFEH 300 03 form?

Yes, you can pursue your case in court after filing the DFEH 300 03 form. If you prefer to take legal action, you will need to request a right-to-sue notice from the DFEH. This allows you to move forward with a lawsuit in a California civil court. Be mindful of the time constraints; a federal notice of right-to-sue must be requested within 30 days of receiving the DFEH’s case closure notice, or within 300 days of the alleged discrimination, whichever comes first.

What should I do if I have questions while completing the form?

If you have questions or need assistance while filling out the DFEH 300 03 form, you have several options. Consider reaching out to the DFEH directly via phone or email. They provide resources and staff to help clarify the process. Additionally, seeking guidance from an attorney who specializes in employment law can also be beneficial. Understanding your rights is crucial as you navigate this process.

Common mistakes

Filling out the DFEH 300 03 form accurately is crucial for effectively filing a discrimination complaint. However, many individuals make common mistakes that can hinder their case. One such mistake is failing to provide complete information about the respondent. It's essential to include not only the name and address of the employer or individual but also the correct telephone number. Missing details can slow down the investigation process and may even result in your complaint being reconsidered as incomplete.

Another frequent error involves overlooking the specifics of the discrimination event. Applicants should clearly indicate the date when the most recent or continuing discrimination occurred. Not specifying the date may lead to complications, particularly regarding the timeline for filing a complaint. Not only does it diminish clarity, but it could also affect the complaint's validity. It helps to remember that the DFEH relies on these dates to understand the context and urgency of each case.

In addition, many people neglect to adequately describe the particulars of their situation. The section requiring the description of discriminatory actions should be filled out with clear details. Vague descriptions or generalizations may lead to misunderstandings or a lack of necessary information for the investigating officers. Instead, provide specific examples of the behavior or actions that constituted the discrimination. This will enhance the quality of the investigation and support your claims more effectively.

Lastly, not understanding the implications of the right-to-sue notice can also pose a significant issue. Individuals often check the box for wanting to pursue the matter in court without being fully informed. It’s vital to know that opting for a right-to-sue notice means you are committed to proceeding legally. This decision should not be made lightly and comes with the understanding that you may have to navigate additional legal processes on your own. Taking the time to fully comprehend this step ensures that you are prepared for what lies ahead.

Documents used along the form

The DFEH 300 03 form is essential for individuals filing complaints of discrimination under California's Fair Employment and Housing Act. However, several other forms and documents are often necessary to support the complaint process. Below is a list of common forms that may accompany the DFEH 300 03 form.

  • DFEH Complaint Information Sheet: This sheet collects demographic information from the complainant, including race, ethnicity, and primary language, which helps the DFEH analyze complaints for statistical purposes.
  • Right-to-Sue Notice: If the complainant wishes to pursue a case in court, this notice is essential. It signifies that the DFEH has completed its investigation and the complainant can file a lawsuit within a specific timeframe.
  • EEOC Complaint Form: In cases where federal laws apply, individuals may need to file with the U.S. Equal Employment Opportunity Commission (EEOC) as well. This form starts the federal complaint procedure.
  • Medical Documentation: If the claim involves a disability or medical condition, relevant medical records or documentation should be gathered. This supports the claim of discrimination based on health-related issues.
  • Witness Statements: If there are individuals who can corroborate the complaint, written statements from those witnesses can strengthen the case. These documents provide additional perspectives on the alleged discrimination.

Utilizing these forms and documents can greatly enhance the effectiveness of the complaint process under the California Fair Employment and Housing Act. Gathering all necessary information upfront will help ensure that your complaint is thoroughly evaluated.

Similar forms

The DFEH 300 03 form serves as a crucial document for reporting discrimination in employment situations. Here are eight other forms or documents that are similar, each designed to address discrimination or employment-related issues in various contexts:

  • EEOC Form 5: This form is used to file a charge of discrimination with the Equal Employment Opportunity Commission (EEOC). Like the DFEH form, it gathers details about the complaint, including the nature of the discrimination and relevant parties involved.
  • California Wage Claim Form: This document allows employees to make claims regarding unpaid wages. Similar to the DFEH 300 03, it requests specific information about the employer and the conditions leading to the wage claim.
  • Whistleblower Complaint Form: Used for reporting retaliation against whistleblowers, this form captures the details surrounding the complaint, paralleling the way the DFEH form collects information about discriminatory acts.
  • Health and Safety Complaint Form: Workers can use this form to report unsafe working conditions or employer reprisals. It similarly aims to protect employee rights and requires pertinent information about the complaint.
  • Unemployment Insurance Claim Form: This form helps individuals file for unemployment benefits, especially due to wrongful termination. It shares similarities with the DFEH form regarding the requirement of explaining the circumstances of employment loss.
  • Title IX Complaint Form: Used in educational settings, this form addresses discrimination based on sex, similar to how the DFEH form handles cases of employment discrimination due to sex or other protected categories.
  • ADA Complaint Form: This form is for reporting violations of the Americans with Disabilities Act. It requests information about the nature of the discrimination and the impacted parties, much like the DFEH 300 03.
  • California Family Rights Act (CFRA) Complaint Form: This form seeks to address violations of family leave rights. It, too, demands details similar to those required by the DFEH about the nature of the complaint and the parties involved.

Dos and Don'ts

When completing the DFEH 300 03 form, it's essential to follow some best practices to ensure all necessary information is accurately reported. Here are six important dos and don'ts to guide you:

  • Do: Provide your full name and contact information clearly at the top of the form.
  • Do: Specify the employer or person you are filing a complaint against clearly and accurately.
  • Do: Detail the specific discriminatory actions that you believe occurred with complete descriptions.
  • Do: Include the dates of the most recent or ongoing discrimination; this information is crucial.
  • Don't: Leave any fields blank; each section requires input to avoid processing delays.
  • Don't: Wait too long to file; be mindful of the filing deadlines to ensure your case is heard.

Filling out the form attentively can significantly influence the processing of your complaint. Ensuring completeness and accuracy is key.

Misconceptions

The DFEH 300 03 form is an important document for filing discrimination complaints under California law. However, several misconceptions persist regarding its purpose and requirements. Here are four common misconceptions explained:

  • Misconception 1: The DFEH 300 03 form can only be used for employment-related discrimination.
  • This form is primarily designed for employment discrimination claims. However, individuals may also use it to report discrimination across various areas, including issues related to housing and public accommodations, depending on the situation.

  • Misconception 2: Completing the form guarantees a successful lawsuit against the employer.
  • While submitting the DFEH 300 03 form is a vital step in the complaint process, it does not automatically result in a successful legal case. The effectiveness of a lawsuit depends on various factors, including the strength of the evidence and legal claims involved.

  • Misconception 3: You must have an attorney to file the DFEH 300 03 form.
  • Although having legal representation is beneficial, it is not a requirement to submit the form. Individuals can complete and file the complaint on their own if they feel comfortable doing so.

  • Misconception 4: Filing a complaint will always lead to an investigation by DFEH.
  • Filing the form does not guarantee that the DFEH will pursue an investigation. If the complaint lacks sufficient detail or does not meet specific criteria, it may not be investigated. DFEH staff will review submissions and determine appropriate actions based on their findings.

Key takeaways

Using the DFEH 300 03 form is an important step in addressing employment discrimination in California. Here are key takeaways to help you navigate the process effectively:

  • Understand the Purpose: The DFEH 300 03 form is used to file a complaint of discrimination under the California Fair Employment and Housing Act.
  • Identify the Respondent: Clearly identify the employer or individual against whom you are filing your complaint. Include their contact details and number of employees if known.
  • State Allegations Clearly: Specify the discriminatory actions you faced, such as denial of employment or harassment. Providing precise details strengthens your case.
  • Document the Timeline: Include the dates of the most recent discrimination incidents, as this information is pivotal for your complaint.
  • Request a Right-to-Sue Notice: If you wish to proceed with court action, explicitly request a right-to-sue notice from the DFEH.
  • Know Your Rights: Be aware that you cannot be coerced into filing. Ensure your decision to proceed is free from intimidation or fear of retaliation.
  • Additional Filings: If your complaint involves multiple employers or individuals, complete separate forms for each entity.
  • Signature Requirement: Sign and date your complaint. Confirm that all information provided is true to the best of your knowledge.

Filling out this form accurately and thoroughly can significantly impact the outcome of your complaint. The DFEH process aims to uphold your rights and provide a clear avenue for addressing discrimination concerns.