Arkansas Human Rights Agency Charge (EEOC Little Rock — Arkansas Has No General State FEPA)

CHARGE OF DISCRIMINATION — EEOC LITTLE ROCK AREA OFFICE (Arkansas)

TABLE OF CONTENTS

1. Filing Information
2. Charging Party (Complainant)
3. Respondent (Employer)
4. Bases of Discrimination (Check All That Apply)
5. Date(s) of Discrimination
6. Issue(s) (Adverse Actions)
7. Particulars (Narrative Statement)
8. Reservation of ACRA Rights
9. Request for Action
10. Verification and Signature
11. Arkansas Filing Notes
12. Sources and References

1. FILING INFORMATION

EEOC Charge No. (assigned by EEOC): [________________________________]

EEOC Field Office:

EEOC Little Rock Area Office
820 Louisiana Street, Suite 200
Little Rock, AR 72201
Phone: 1-800-669-4000
Fax: 501-324-5991

Filing Method (check one):

• ☐ Filed online through EEOC Public Portal (publicportal.eeoc.gov)
• ☐ Filed in person at Little Rock Area Office
• ☐ Filed by mail (signed and verified under penalty of perjury)
• ☐ Filed via scheduled telephone interview
• ☐ Filed via attorney representation (Form 138 / NDA on file)

Date Charge Filed: [__/__/____]

State Agency Concurrent Filing: ☐ N/A — Arkansas has no general state human rights commission for employment discrimination.

2. CHARGING PARTY (Complainant)

Name: [FULL LEGAL NAME]

Street Address: [ADDRESS]

City, State, ZIP: [CITY], AR [ZIP]

Telephone: [NUMBER]

Email: [EMAIL]

Date of Birth: [__/__/____] (required for ADEA charges only)

Counsel (if any):

• Name: [ATTORNEY NAME], Ark. Bar No. [____]
• Firm: [FIRM]
• Address: [ADDRESS]
• Phone: [NUMBER]
• Email: [EMAIL]

3. RESPONDENT (Employer)

Name of Employer / Organization: [EMPLOYER NAME]

Street Address: [ADDRESS]

City, State, ZIP: [CITY], [STATE] [ZIP]

County (Arkansas): [COUNTY]

Telephone: [NUMBER]

Number of Employees:

• ☐ 1–14 (insufficient for Title VII; ACRA requires 9+)
• ☐ 15–100
• ☐ 101–200
• ☐ 201–500
• ☐ 501+

Type of Business: [INDUSTRY / NAICS CODE]

Federal Contractor (if known): ☐ Yes ☐ No (if Yes, OFCCP jurisdiction may apply)

4. BASES OF DISCRIMINATION (Check All That Apply)

I believe I have been discriminated against because of my:

• ☐ Race (Title VII, 42 U.S.C. § 2000e-2; ACRA § 16-123-107) — specify: [________________________________]
• ☐ Color (Title VII)
• ☐ National Origin (Title VII; ACRA)
• ☐ Religion (Title VII; ACRA)
• ☐ Sex / Gender (Title VII; ACRA), including:
• ☐ Pregnancy (PDA)
• ☐ Sexual harassment
• ☐ Sexual orientation (Title VII per Bostock)
• ☐ Gender identity (Title VII per Bostock)
• ☐ Age (40+) (ADEA, 29 U.S.C. § 623) — note: NOT covered by ACRA
• ☐ Disability (ADA, 42 U.S.C. § 12112; ACRA), including:
• ☐ Failure to accommodate
• ☐ Regarded-as discrimination
• ☐ Record of impairment
• ☐ Genetic Information (GINA, 42 U.S.C. § 2000ff-1)
• ☐ Equal Pay (Equal Pay Act, 29 U.S.C. § 206(d))
• ☐ Retaliation (Title VII § 704(a); ADA § 12203; ADEA § 623(d); ACRA § 16-123-108) for:
• ☐ Opposing unlawful practice
• ☐ Filing prior charge
• ☐ Participating in investigation
• ☐ Requesting accommodation
• ☐ Other: [________________________________]

5. DATE(S) OF DISCRIMINATION

Earliest date: [__/__/____]

Latest date: [__/__/____]

☐ Continuing Action — discriminatory conduct is ongoing or constitutes a continuing violation under National R.R. Passenger Corp. v. Morgan, 536 U.S. 101 (2002).

6. ISSUE(S) (Adverse Actions)

I believe I was subjected to the following adverse employment action(s):

• ☐ Discharge / termination
• ☐ Constructive discharge (forced resignation)
• ☐ Failure to hire
• ☐ Failure to promote
• ☐ Demotion
• ☐ Suspension
• ☐ Reduction in pay or hours
• ☐ Disciplinary action / write-up
• ☐ Denial of leave or accommodation
• ☐ Harassment / hostile work environment
• ☐ Unequal terms and conditions
• ☐ Job assignment / shift change
• ☐ Training denial
• ☐ Reference / blacklisting
• ☐ Other: [________________________________]

7. PARTICULARS (Narrative Statement)

A. Personal Background.

I, [FULL NAME], am a [AGE]-year-old [RACE / NATIONAL ORIGIN / GENDER / RELIGION / DISABILITY STATUS] individual residing in [CITY], [COUNTY] County, Arkansas. I am a member of the following protected class(es) under Title VII, the ADA, the ADEA, GINA, and/or the Arkansas Civil Rights Act: [IDENTIFY CLASSES].

B. Employment History.

I was hired by Respondent [EMPLOYER NAME] on or about [DATE] as a [POSITION TITLE] at Respondent's location at [WORKSITE ADDRESS] in [CITY], Arkansas. My duties included [BRIEF JOB DESCRIPTION]. Throughout my employment, I performed at a satisfactory or above-satisfactory level, as evidenced by [PERFORMANCE REVIEWS / AWARDS / PROMOTIONS / RAISES].

C. Discriminatory Conduct.

1. On or about [DATE], [NAME OF ACTOR — TITLE] [DESCRIBE INCIDENT — what was said, what was done, who was present].

2. On or about [DATE], [DESCRIBE NEXT INCIDENT].

3. On or about [DATE], [DESCRIBE NEXT INCIDENT].

4. The pattern of conduct described above culminated in [FINAL ADVERSE ACTION — termination, demotion, etc.] on [DATE].

D. Comparator Evidence.

Similarly situated employees outside my protected class were treated more favorably. Specifically:

• [NAME / IDENTIFIER OF COMPARATOR 1], a [NON-PROTECTED-CLASS DESCRIPTION] employee in a similar position, was [describe more favorable treatment].
• [COMPARATOR 2]: [treatment].
• [COMPARATOR 3]: [treatment].

E. Pretext.

Respondent has stated that the reason for the adverse action was [STATED REASON]. That stated reason is pretextual because [FACTS SHOWING PRETEXT — shifting explanations, inconsistent application of policy, contemporaneous discriminatory remarks, departure from procedure, etc.].

F. Protected Activity (if retaliation alleged).

On or about [DATE], I engaged in protected activity by [DESCRIBE — internal complaint to HR, filing prior charge, supporting another employee's claim, requesting accommodation, etc.]. Respondent and/or its agents had actual knowledge of this protected activity. Within [NUMBER] [days/weeks] after my protected activity, Respondent took the materially adverse action described above.

G. Failure to Accommodate (if ADA / religion / pregnancy alleged).

On or about [DATE], I requested the following reasonable accommodation: [DESCRIBE REQUEST]. Respondent [denied the request / failed to engage in interactive process / provided ineffective accommodation / delayed unreasonably] in violation of [42 U.S.C. § 12112(b)(5) (ADA) / Title VII § 701(j) (religion) / PWFA / ACRA].

H. Damages.

As a direct and proximate result of Respondent's discriminatory and retaliatory conduct, I have suffered:

• Loss of wages and benefits totaling approximately $[AMOUNT] to date;
• Loss of future earning capacity;
• Emotional distress, anxiety, humiliation, and mental anguish;
• Damage to professional reputation;
• Out-of-pocket expenses for [medical / counseling / job-search] in the approximate amount of $[AMOUNT].

I. Statement of Belief.

I believe Respondent discriminated and/or retaliated against me because of my [PROTECTED CLASS] in violation of [Title VII / ADA / ADEA / GINA / EPA] and the Arkansas Civil Rights Act of 1993, Ark. Code Ann. § 16-123-101 et seq.

8. RESERVATION OF ACRA RIGHTS

By filing this Charge with the EEOC, I do not waive — and expressly preserve — my private right of action under the Arkansas Civil Rights Act of 1993, Ark. Code Ann. § 16-123-107, which permits direct suit in Arkansas Circuit Court (or in federal court via supplemental jurisdiction) without administrative exhaustion. Pursuant to Ark. Code Ann. § 16-123-107(c)(3), I am required to file any ACRA action within ONE (1) YEAR of the alleged unlawful employment practice OR within ninety (90) days of receipt of an EEOC Notice of Right to Sue or Determination, whichever is LATER.

9. REQUEST FOR ACTION

Charging Party requests that the Commission:

• ☐ Investigate the allegations contained in this Charge;
• ☐ Offer the parties EEOC mediation under the EEOC Alternative Dispute Resolution program;
• ☐ Issue a Letter of Determination upon completion of the investigation;
• ☐ Issue a Notice of Right to Sue at the earliest date permitted by 29 C.F.R. § 1601.28;
• ☐ Pursue conciliation and, if unsuccessful, litigation under § 706 of Title VII;
• ☐ Promptly serve a copy of this Charge on Respondent pursuant to 29 C.F.R. § 1601.14.

10. VERIFICATION AND SIGNATURE

I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge, information, and belief.

Date: [__/__/____]

Signature of Charging Party: [________________________________]

[PRINTED NAME]

11. ARKANSAS FILING NOTES

• Arkansas has NO general state human rights agency for employment claims. Section 1601.13 describes federal filing and deferral treatment for jurisdictions with or without a qualifying FEP agency; it is not a state-specific worksharing agreement. Confirm the current EEOC agency list and filing instructions before relying on this classification. Charges are filed directly with the EEOC. The Arkansas Civil Rights Act of 1993 supplies a parallel private right of action that does NOT require administrative exhaustion. Ark. Code Ann. § 16-123-107(c).
• 180-day deadline (not 300). Because Arkansas lacks a qualifying state agency, the Title VII / ADA / GINA filing window is 180 calendar days from the last act of discrimination, NOT 300 days. ADEA is also 180 days. Calendar conservatively.
• Arkansas Department of Labor and Licensing handles wage-and-hour, workplace safety (Ark. OSH), and licensing — NOT discrimination charges. URL: https://www.labor.arkansas.gov/.
• Arkansas Fair Housing Commission accepts HOUSING discrimination charges only (Ark. Code §§ 16-123-301 to -348). For employment, file with EEOC. URL: https://ig.arkansas.gov/fair-housing/.
• Local civil-rights policies. Ark. Code § 14-1-403 generally bars local ordinances or policies creating protected classes or discrimination prohibitions beyond state law; subsection (b) excepts policies applying only to a political subdivision's employees. Verify any current local provision and its enforcement route before relying on it. A local policy is not itself a qualifying FEPA for the Title VII filing period.
• Federal-sector employees. Federal employees and applicants must use the agency EEO process under 29 C.F.R. Part 1614, NOT the EEOC Little Rock Area Office. Initial counselor contact required within 45 days.
• Equal Pay Act. EPA charges are accepted by EEOC but are NOT required before suit. The EPA SOL is two years (three for willful), running from each unequal paycheck.
• Mediation. EEOC offers free, confidential mediation through the Little Rock Area Office. Acceptance is voluntary for both parties; mediation can resolve charges in 60-90 days.
• Notice of Right to Sue. Title VII / ADA / GINA: request after 180 days (29 C.F.R. § 1601.28(a)(1)) or wait for EEOC determination. Early issuance before 180 days requires the applicable certification under subsection (a)(2). ADEA: 60 days after charge filing is sufficient; no RTS required. After RTS, plaintiff has 90 days to file federal-court complaint.
• ACRA preservation. Always file the EEOC charge to (i) preserve federal claims and (ii) trigger the "later of one year or 90 days post-RTS" rule under § 16-123-107(c)(3) for ACRA. Failing to file an EEOC charge limits the ACRA SOL trigger to the strict one-year clock.
• Class allegations. EEOC accepts class-style charges; if discrimination is systemic, plead the policy or practice and identify potential class members.
• Confidentiality. Charges are confidential during investigation under 42 U.S.C. § 2000e-5(b), but disclosed to Respondent in EEOC's notice (typically within 10 days of filing).
• Continuing violations. Hostile-work-environment claims may include conduct outside the 180-day window if at least one act falls within the period (Morgan, 536 U.S. 101). Discrete acts (termination, demotion) cannot be daisy-chained.

12. SOURCES AND REFERENCES

• EEOC Little Rock Area Office — https://www.eeoc.gov/field-office/littlerock
• EEOC Public Portal (online filing) — https://publicportal.eeoc.gov/
• EEOC Form 5 (Charge of Discrimination) — https://www.eeoc.gov/employees/timeliness
• 42 U.S.C. § 2000e-5 (Title VII enforcement) — https://www.eeoc.gov/statutes/title-vii-civil-rights-act-1964
• 29 C.F.R. Part 1601 (EEOC procedures) — https://www.ecfr.gov/current/title-29/subtitle-B/chapter-XIV/part-1601
• 29 C.F.R. § 1601.13 (EEOC filing and FEPA deferral; agency agreements separate)
• 29 C.F.R. § 1601.28 (Notice of Right to Sue procedures)
• Ark. Code Ann. § 16-123-101 et seq. (ACRA) — https://law.justia.com/codes/arkansas/title-16/subtitle-7/chapter-123/subchapter-1/
• Ark. Code Ann. § 16-123-107 (private right of action; SOL) — https://law.justia.com/codes/arkansas/title-16/subtitle-7/chapter-123/subchapter-1/section-16-123-107/
• Arkansas Department of Labor and Licensing — https://www.labor.arkansas.gov/
• Arkansas Fair Housing Commission — https://ig.arkansas.gov/fair-housing/
• Legal Aid of Arkansas — Filing a Title VII Claim — https://a.arlawhelp.org/employment/discrimination-disability-rights/filing-a-VII-claim
• National R.R. Passenger Corp. v. Morgan, 536 U.S. 101 (2002) (continuing violation)
• Bostock v. Clayton County, 590 U.S. 644 (2020) (Title VII covers sexual orientation and gender identity)
• McDonnell Douglas Corp. v. Green, 411 U.S. 792 (1973) (burden-shifting)
• Faragher v. City of Boca Raton, 524 U.S. 775 (1998) (employer liability)
• Burlington Industries, Inc. v. Ellerth, 524 U.S. 742 (1998) (supervisor liability)

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney licensed in Arkansas must review and customize this document before submission. Filing deadlines under Title VII, ADA, ADEA, GINA, and ACRA are strictly enforced and short; verify all dates and coverage before filing.