Maine Employment Discrimination Charge Preparation Worksheet
MAINE EMPLOYMENT DISCRIMINATION CHARGE PREPARATION WORKSHEET
Before you use this: Completing the Maine Human Rights Commission's intake questionnaire does not necessarily file a complaint. The Commission may draft a complaint for your review; it considers the complaint filed when it receives the signed, notarized form. Under 5 M.R.S. § 4611, an aggrieved person's complaint must be filed within 300 days after the alleged act of unlawful discrimination. Start promptly through the Commission's File a Complaint page, and contact the Commission if you need help or the deadline may be close.
This worksheet organizes information for the Commission's current intake process. It is not a substitute for the official questionnaire or the later sworn complaint.
1. IDENTIFY THE PEOPLE AND EMPLOYMENT RELATIONSHIP
Your name: [________________________________]
Phone, email, and mailing address: [________________________________]
Employer or employment agency name and address: [________________________________]
Your position, application, or other employment relationship: [________________________________]
Relevant employment dates: [________________________________]
People involved, with their roles if known: [________________________________]
2. PREPARE A SPECIFIC ACCOUNT
The Commission asks for an explanation of exactly what happened, with names and dates. State the facts you observed and why you believe the treatment involved a protected characteristic or legally protected activity. Do not assume a comparison or motive you cannot support.
| Date | Event or decision | Person involved | Record or witness |
|---|---|---|---|
| [__/__/____] | [WHAT HAPPENED] | [NAME AND ROLE] | [EMAIL, DOCUMENT, OR WITNESS] |
| [__/__/____] | [WHAT HAPPENED] | [NAME AND ROLE] | [EMAIL, DOCUMENT, OR WITNESS] |
| [__/__/____] | [WHAT HAPPENED] | [NAME AND ROLE] | [EMAIL, DOCUMENT, OR WITNESS] |
Date of the most recent act you want reviewed: [__/__/____]
Protected characteristic or activity you believe is involved: [________________________________]
Explain how the facts relate to that characteristic or activity:
[____________________________________________________________]
[____________________________________________________________]
What did the employer or other person tell you about the decision, if anything?
[____________________________________________________________]
What different treatment of others do you know firsthand, if any?
[____________________________________________________________]
3. PRIOR STEPS AND RECORDS
Did you report the concern to a supervisor, human resources office, union, or agency? Give dates, contacts, and responses.
[____________________________________________________________]
[____________________________________________________________]
Records to identify for the Commission: ☐ Letters or emails ☐ Job records ☐ Policy or handbook pages ☐ Witness names ☐ Other: [________________]
What outcome are you asking the Commission to consider? [________________________________]
4. COMPLETE THE COMMISSION PROCESS
☐ Use the Commission's current intake route and follow its intake instructions. Transfer your own factual account to the official questionnaire.
☐ If an Intake Officer sends a draft complaint, review the names, dates, factual allegations, and requested action; ask for corrections where needed.
☐ Follow the Commission's directions for signing and notarizing the official complaint and returning it in time. Keep proof of receipt.
☐ Record the date the Commission confirms that it received your signed, notarized complaint.
Intake submitted: [__/__/____] Signed complaint received, if confirmed: [__/__/____]
For questions, the Commission lists 207-624-6290 and [email protected] on its filing page.
Official sources
About this template
- Last updated
- October 27, 2026
- Citations checked
- October 27, 2026
- Jurisdiction
- Maine
- Category
- Employment & HR
Legal authority
- 5 M.R.S. § 4611
- Maine Human Rights Commission, Instructions for Intake Form
Employment documents govern the relationship between a company and its workers, from offer letters and employment agreements through handbooks, performance reviews, and separations. Done right, they set clear expectations, protect against wrongful termination and discrimination claims, and give both sides a record to rely on. Done poorly, they invite lawsuits, agency complaints, and costly disputes.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on October 27, 2026.
5 M.R.S. § 4611 (checked October 27, 2026): "Any aggrieved person, or any employee of the commission, may file a complaint under oath with the commission stating the facts concerning the alleged discrimination, except that a complaint must be filed with the commission not more than 300 days after the alleged act of unlawful discrimination."
Maine Human Rights Commission, Instructions for Intake Form (checked October 27, 2026): "A perfected complaint of discrimination is filed with the Maine Human Rights Commission when a signed, notarized complaint form is received by the commission."
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