South Dakota Employment Discrimination Intake - Preparation Worksheet
SOUTH DAKOTA EMPLOYMENT DISCRIMINATION INTAKE - PREPARATION WORKSHEET
Use: Complete the Division of Human Rights employment Charging Party Intake Form using your verified facts. This worksheet is for preparation and is not the intake or a formal charge. The Division's charge guide says it drafts a separate charge after reviewing the intake. Check that charge carefully and arrange its notarized signing. Under S.D. Codified Laws § 20-13-31, a state charge must be filed within 180 days after the alleged practice. Start early enough for the agency's review and your signing.
1. Your contact information
Full legal name: [NAME]
Mailing address: [STREET, CITY, STATE, ZIP]
Telephone and safe email: [DETAILS]
Best way and time to contact you: [DETAILS]
Representative, if any: [NAME AND CONTACT OR NONE]
2. Employer or other respondent
Employer's full legal name: [NAME]
Worksite address: [STREET, CITY, STATE, ZIP]
Employer's mailing address if different: [ADDRESS OR SAME]
Supervisor or decision maker involved: [NAME, TITLE, CONTACT IF KNOWN]
Your job or position sought: [TITLE]
Employment or application dates: [START DATE] to [END DATE OR PRESENT]
3. Basis and action
Check only bases you believe the facts support under S.D. Codified Laws § 20-13-10:
☐ Race ☐ Color ☐ Creed ☐ Religion ☐ Sex ☐ Ancestry ☐ Disability ☐ National origin
What happened to you: ☐ Refusal to hire ☐ Discharge ☐ Unequal pay ☐ Denied promotion or training ☐ Harassment or unequal conditions ☐ Other: [DESCRIBE]
Most recent date of the practice: [__/__/____]
Earlier related dates: [DATES OR NONE]
Why you believe the checked basis affected the decision: [SPECIFIC WORDS, EVENTS, COMPARISONS, OR RECORDS]
4. Factual account
List events in time order. Separate what you directly saw or heard from what another person told you.
| Date and place | People involved | What occurred and how you know | Supporting record or witness |
|---|---|---|---|
| [DATE, PLACE] | [NAMES] | [FACTS] | [DOCUMENT OR NAME] |
| [DATE, PLACE] | [NAMES] | [FACTS] | [DOCUMENT OR NAME] |
Employer's stated reason, if any: [EXACT WORDS AND SOURCE OR NONE]
People treated differently in similar circumstances, if known: [NAMES, WHAT WAS DIFFERENT, BASIS FOR KNOWLEDGE OR NONE]
Witness names and safe contact details: [DETAILS OR NONE]
Documents you can supply: ☐ Application ☐ Offer or contract ☐ Pay records ☐ Schedule ☐ Messages ☐ Reviews ☐ Discipline or termination records ☐ Other: [LIST]
Effect on your work, earnings, or other interests: [FACTS AND DATES]
Prior report to employer or agency, if any: [TO WHOM, WHEN, WHAT WAS SAID, RESPONSE OR NONE]
5. Filing handoff
☐ Check the current agency forms page and complete, sign, and submit the employment intake there. Follow the agency's directions for any additional questionnaire.
☐ Keep a copy of what you submit and record the submission date and confirmation number: [DETAILS].
☐ Respond to the Division's follow-up and review the separate formal charge it drafts. Correct any factual errors before signing it.
☐ Arrange notarization of the formal charge and confirm the Division receives it in time for the applicable filing deadline. The intake alone does not file the charge.
Person monitoring the charge deadline: [NAME] Calendar date to confirm with the Division: [__/__/____]
Official sources
About this template
- Last updated
- November 2, 2026
- Citations checked
- November 2, 2026
- Jurisdiction
- South Dakota
- Category
- Employment & HR
Legal authority
- S.D. Codified Laws § 20-13-10 (employment practices)
- S.D. Codified Laws § 20-13-29 (verified charge and content)
- S.D. Codified Laws § 20-13-31 (180-day filing limit)
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 2, 2026.
S.D. Codified Laws § 20-13-10 (checked November 2, 2026): "It is an unfair or discriminatory practice for any person, because of race, color, creed, religion, sex, ancestry, disability, or national origin, to fail or refuse to hire, to discharge an employee, or to accord adverse or unequal treatment to any person, employee, or intern with respect to application, hiring, training, apprenticeship, tenure, promotion, upgrading, compensation, layoff, or any term or condition of employment."
S.D. Codified Laws § 20-13-29 (checked November 2, 2026): "Any person claiming to be aggrieved by a discriminatory or unfair practice may file with the Division of Human Rights a verified, written charge which shall state the name and address of the person or agency alleged to have committed the discriminatory or unfair practice. The charge shall set forth the facts upon which it is based, and shall contain any other information required by the division."
S.D. Codified Laws § 20-13-31 (checked November 2, 2026): "Any charge filed under this chapter shall be filed within one hundred and eighty days after the alleged discriminatory or unfair practice occurred."
South Dakota DLR Human Rights forms page (checked November 2, 2026): "Please complete, sign, and submit the online fillable forms below. Do not print blank forms—they will not be correct."
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