Wyoming Employment Discrimination Charge Preparation Worksheet
WYOMING EMPLOYMENT DISCRIMINATION CHARGE PREPARATION WORKSHEET
Before you use this: The Wyoming Department of Workforce Services asks a person to submit its current intake questionnaire. An officer then prepares a charge draft for review; the claimant signs, notarizes, and returns that charge. This worksheet is for organizing the facts before using the agency's current questionnaires. Submitting this worksheet does not file a charge. Wyo. Stat. § 27-9-106(a) sets a six-month period after the alleged violation for filing the verified written complaint. Contact the agency promptly if that date is close.
Person and employer
Your name: [________________________________]
Private mailing address, phone, and email: [________________________________]
Employer, employment agency, or labor organization name: [________________________________]
Its address and contact person, if known: [________________________________]
Your position or application, and work dates: [________________________________]
Account of what happened
Describe only events you know. Include each decision, date, person involved, and any explanation given to you. Wyo. Stat. § 27-9-106(a) calls for the particulars of the claim.
| Date | Decision or event | People involved | Document or witness |
|---|---|---|---|
| [__/__/____] | [FACTS] | [NAMES AND ROLES] | [RECORD OR WITNESS] |
| [__/__/____] | [FACTS] | [NAMES AND ROLES] | [RECORD OR WITNESS] |
Date of the alleged violation you want reviewed: [__/__/____]
Why you believe the decision involved a characteristic covered by Wyo. Stat. § 27-9-105(a)(i) or (ii): [AGE / SEX / RACE / CREED / COLOR / NATIONAL ORIGIN / ANCESTRY / PREGNANCY / QUALIFIED DISABILITY / OTHER LAW IDENTIFIED BY COUNSEL]
If age is the basis: Wyoming’s age provision covers people at least 40 years old.
Facts connecting the decision to that characteristic, including any comparison you can support:
[____________________________________________________________]
If disability is involved, describe the job and any accommodation relevant to performing it, without putting medical records here:
[____________________________________________________________]
What you reported internally, to whom, when, and the response:
[____________________________________________________________]
Documents and witnesses to identify for the agency: [________________________________]
Outcome you want the agency to consider: [________________________________]
Complete the agency process
☐ Transfer the relevant facts to the agency's General or Disability Intake Questionnaire, as appropriate, and follow its submission instructions.
☐ Review the formal charge draft sent by the agency. Correct names, dates, and allegations before signing.
☐ Follow the agency's instructions to sign, notarize, and return its formal charge. Keep a copy and proof of delivery. Ask the agency to confirm whether and when it was filed.
Questionnaire sent on: [__/__/____] Agency receipt confirmed on: [__/__/____]
Signed charge returned on: [__/__/____] Filing confirmed on: [__/__/____]
Official sources
About this template
- Last updated
- November 3, 2026
- Citations checked
- November 3, 2026
- Jurisdiction
- Wyoming
- Category
- Employment & HR
Legal authority
- Wyo. Stat. § 27-9-105(a)(i)-(ii), (b), (d)
- Wyo. Stat. § 27-9-106(a)
- Wyoming Department of Workforce Services, How to File a Charge
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 November 3, 2026.
Wyo. Stat. § 27-9-105(a)(i) (checked November 3, 2026): "For an employer to refuse to hire, to discharge, to promote or demote, or to discriminate in matters of compensation or the terms, conditions or privileges of employment against, a qualified disabled person or any person otherwise qualified, because of age, sex, race, creed, color, national origin, ancestry or pregnancy;"
Wyo. Stat. § 27-9-105(b) (checked November 3, 2026): "The prohibitions against discrimination based on age in this section apply only to persons at least forty (40) years of age."
Wyo. Stat. § 27-9-105(d) (checked November 3, 2026): "As used in this section "qualified disabled person" means a disabled person who is capable of performing a particular job, or who would be capable of performing a particular job with reasonable accommodation to his disability."
Wyo. Stat. § 27-9-106(a) (checked November 3, 2026): "Any person claiming to be aggrieved by a discriminatory or unfair employment practice may, personally or through his attorney, make, sign and file with the department within six (6) months of the alleged violation a verified, written complaint in duplicate which shall state the name and address of the person, employer, employment agency or labor organization alleged to have committed the discriminatory or unfair employment practice, and which shall set forth the particulars of the claim and contain other information as shall be required by the department."
Draft your Wyoming Employment Discrimination Charge Preparation Worksheet in the editor
Answer a few questions, let the AI editor draft each section from your answers, review it, and download Word and PDF. $99 one time, or $249 per month for every document and every Ezel app.