Arizona Civil Rights Division (ACRD) Charge of Discrimination

ARIZONA CIVIL RIGHTS DIVISION — CHARGE OF DISCRIMINATION

TABLE OF CONTENTS

1. Filing Information
2. Charging Party Information
3. Respondent Information
4. Cause of Discrimination
5. Date(s) of Discrimination
6. Particulars of the Charge
7. Dual-Filing Election
8. Verification and Signature
9. Cover Letter to ACRD
10. Attorney Representation Notice
11. Document Preservation Demand
12. Arizona Practice Notes
13. Sources and References

1. FILING INFORMATION

ARIZONA CIVIL RIGHTS DIVISION

Office of the Arizona Attorney General

2005 North Central Avenue, Suite 200

Phoenix, Arizona 85004-2926

Telephone: (602) 542-5263 | TTY: (602) 542-5002 | Toll-Free: (877) 491-5742

Web: https://www.azag.gov/civil-rights

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

EEOC No. (assigned upon dual filing): [________________________________]

Date Filed: [__/__/____]

2. CHARGING PARTY INFORMATION

3. RESPONDENT INFORMATION

4. CAUSE OF DISCRIMINATION

Check all that apply (Unicode boxes — do not modify):

☐ Race

☐ Color

☐ Religion

☐ Sex (including sexual harassment)

☐ Pregnancy / Childbirth / Related Medical Condition

☐ National Origin

☐ Age (40 and over)

☐ Disability (physical or mental)

☐ Genetic Information

☐ Retaliation (for opposing discrimination or participating in proceedings)

☐ Other (specify): [________________________________]

Statutory bases: A.R.S. § 41-1463; A.R.S. § 41-1464 (retaliation); 42 U.S.C. § 2000e-2; 42 U.S.C. § 12112 (ADA); 29 U.S.C. § 623 (ADEA); 42 U.S.C. § 2000ff-1 (GINA).

5. DATE(S) OF DISCRIMINATION

6. PARTICULARS OF THE CHARGE

I, [CHARGING PARTY NAME], charge Respondent [RESPONDENT NAME] with the following discriminatory acts in violation of the Arizona Civil Rights Act, A.R.S. § 41-1463, and Title VII of the Civil Rights Act of 1964, 42 U.S.C. § 2000e et seq. (and/or other federal statutes as applicable):

6.1. Background and Employment History

I was hired by Respondent on or about [DATE] as a [POSITION TITLE] at Respondent's [LOCATION] facility. Throughout my employment, I performed my duties satisfactorily, as evidenced by [performance reviews / commendations / promotions / awards].

6.2. My Protected Class

I am [describe protected status — e.g., a Black woman over the age of 40 / an individual with a documented disability of [condition] / a Christian / pregnant at the time of the adverse action]. Respondent was aware of my protected status because [DESCRIBE — visible characteristic, disclosed condition, request for accommodation, etc.].

6.3. Discriminatory Acts

The following discriminatory acts occurred:

• [Date]: [Detailed description of incident, including names, titles, statements made, witnesses, and the protected basis];
• [Date]: [Detailed description];
• [Date]: [Detailed description];
• [Date]: [Final adverse action — termination, demotion, denial of accommodation, etc.].

6.4. Comparator and Pattern Evidence

Similarly situated employees outside my protected class were treated more favorably, including:

• [Comparator name, role, and treatment];
• [Comparator name, role, and treatment].

I am also aware of the following pattern evidence: [describe other affected employees, statistical patterns, prior complaints].

6.5. Internal Complaints and Retaliation

On [DATE], I complained internally to [HR / SUPERVISOR / ETHICS HOTLINE] about the discriminatory conduct. After that complaint, Respondent [describe retaliatory acts — write-ups, schedule changes, demotion, termination] in retaliation for my protected activity, in violation of A.R.S. § 41-1464 and 42 U.S.C. § 2000e-3(a).

6.6. Failure to Accommodate (if applicable)

On [DATE], I requested a reasonable accommodation for my disability / religion, specifically [describe accommodation requested]. Respondent [denied / failed to engage in the interactive process / provided an inadequate accommodation], in violation of A.R.S. § 41-1463(F)(4) and 42 U.S.C. § 12112(b)(5).

6.7. Pretext

The reason(s) Respondent has offered or is likely to offer for the adverse action — [stated reason] — are pretextual because [explain inconsistencies, shifting explanations, evidence the reason is false].

6.8. Harm Suffered

As a result of Respondent's unlawful conduct, I have suffered:

• Loss of wages and benefits totaling approximately $[AMOUNT] to date;
• Loss of future earnings and career advancement;
• Emotional distress, anxiety, depression, sleep disturbance, and humiliation;
• Damage to my professional reputation;
• [Other harm — medical expenses, relocation costs, etc.].

6.9. Witnesses

The following individuals have personal knowledge of the facts described:

6.10. Supporting Documents

I have or can obtain the following documents in support of this Charge:

☐ Offer letter and employment contract

☐ Job description

☐ Performance evaluations

☐ Disciplinary records

☐ Termination letter or notice of adverse action

☐ Internal complaint correspondence

☐ Emails, text messages, and Slack/Teams messages

☐ Pay records and benefit statements

☐ Medical records (for disability or pregnancy claims)

☐ Accommodation request correspondence

☐ Witness statements

☐ Other: [________________________________]

7. DUAL-FILING ELECTION

I want this Charge filed with both the Arizona Civil Rights Division and the U.S. Equal Employment Opportunity Commission (EEOC).

☐ Yes — Dual-file under the ACRD-EEOC Work-Sharing Agreement (extends deadline to 300 days under federal law).

☐ No — File only with ACRD (180-day Arizona deadline).

For housing claims: Charges filed with ACRD are deemed dual-filed with the U.S. Department of Housing and Urban Development (HUD) under ACRD's Fair Housing Assistance Program designation.

I have not filed this Charge with any other state or local agency except as indicated above.

8. VERIFICATION AND SIGNATURE

I declare under penalty of perjury under the laws of the State of Arizona that the foregoing is true and correct to the best of my knowledge, information, and belief. I understand that this Charge will be filed with both ACRD and the EEOC (where applicable), and I authorize the agencies to disclose information consistent with their procedures.

Date: [__/__/____]

[________________________________]

[CHARGING PARTY NAME]

STATE OF ARIZONA

COUNTY OF [COUNTY]

Subscribed and sworn to (or affirmed) before me this [____] day of [_______________], 20[____], by [CHARGING PARTY NAME].

[________________________________]

Notary Public

(My Commission Expires: [_______________])

9. COVER LETTER TO ACRD

[DATE]

Arizona Civil Rights Division

Office of the Arizona Attorney General

2005 North Central Avenue, Suite 200

Phoenix, AZ 85004-2926

Re: Charge of Discrimination — [CHARGING PARTY NAME] v. [RESPONDENT NAME]

Dear Civil Rights Division Investigator:

Enclosed please find the verified Charge of Discrimination filed by [CHARGING PARTY NAME] against [RESPONDENT NAME] alleging unlawful [employment / housing / public-accommodations] discrimination on the basis of [PROTECTED CHARACTERISTIC(S)] in violation of A.R.S. § 41-1463 [and parallel federal law].

This Charge is timely filed within the [180-day / 300-day / one-year] window provided by A.R.S. § 41-1481(B). The Charging Party requests dual-filing with the EEOC under the ACRD-EEOC Work-Sharing Agreement.

The Charging Party respectfully requests that ACRD:

1. Open a formal investigation into the allegations;
2. Issue a Notice of Charge to Respondent and require a position statement;
3. Preserve all subpoena and conciliation rights under A.R.S. § 41-1481;
4. Provide the Charging Party with copies of all correspondence and findings;
5. Issue a Notice of Right to Sue upon completion of the investigation or upon the Charging Party's request after the 90-day investigation window.

Please direct all correspondence to undersigned counsel.

Respectfully,

[________________________________]

[ATTORNEY NAME], State Bar of Arizona No. [####]

[LAW FIRM NAME]

[ADDRESS]

[PHONE / EMAIL]

Counsel for Charging Party

Enclosures: Verified Charge of Discrimination; Notice of Representation; Document Preservation Demand; Supporting Exhibits A–[__]

10. ATTORNEY REPRESENTATION NOTICE

The undersigned attorney represents the Charging Party in this matter. All correspondence, requests for information, and notices should be directed to counsel of record at the address below. Direct contact with the Charging Party regarding this Charge is not permitted without counsel's consent.

[ATTORNEY NAME], State Bar of Arizona No. [####]

[LAW FIRM NAME]

[ADDRESS]

[PHONE / EMAIL]

11. DOCUMENT PRESERVATION DEMAND

To: [RESPONDENT NAME]

You are hereby placed on notice that [CHARGING PARTY NAME] has filed a Charge of Discrimination against you with the Arizona Civil Rights Division and the EEOC. You must immediately implement a litigation hold and preserve all documents and electronically stored information ("ESI") that may be relevant to the claims, including but not limited to:

• Personnel files for the Charging Party and all comparators identified in the Charge;
• Performance evaluations, disciplinary records, attendance records, and pay records;
• Emails, text messages, instant messages, Slack/Teams messages, and voicemails involving the Charging Party, comparators, or decision-makers;
• HR files, complaint logs, investigation files, and EEO records;
• Surveillance video, badge-access records, and computer-login records;
• Hiring, firing, promotion, and demotion records for the Charging Party's department or work unit;
• Policies, handbooks, and training materials;
• Calendars, meeting notes, and one-on-one records of decision-makers.

Failure to preserve relevant evidence may result in spoliation sanctions, including adverse-inference instructions, monetary sanctions, and the striking of defenses.

12. ARIZONA PRACTICE NOTES

• Strict deadlines. Employment, public-accommodations, and voting charges must be filed with ACRD within 180 days of the discriminatory act, or 300 days if dual-filed with EEOC under the work-share agreement. Housing charges have a one-year window. Discrete acts (termination, demotion, pay decisions) each trigger their own filing clock per National Railroad Passenger Corp. v. Morgan, 536 U.S. 101 (2002).
• Coverage. ACRA's employer threshold is fifteen (15) or more employees for race, color, religion, sex, national origin, pregnancy, and disability claims, and twenty (20) or more for age claims. Sub-threshold employers may still be covered by federal anti-discrimination statutes for some claims (e.g., § 1981 for race) or by Arizona common-law wrongful-discharge tort principles.
• Work-share with EEOC. ACRD and EEOC operate under a Worksharing Agreement: a charge filed with one agency is deemed filed with the other. The first agency to receive the charge typically processes it. See 29 C.F.R. § 1601.13.
• FHAP designation. ACRD is a HUD-certified Fair Housing Assistance Program agency, so housing charges filed with ACRD are deemed dual-filed with HUD under 42 U.S.C. § 3610(f).
• Investigation process. After filing, ACRD performs a preliminary jurisdictional review, sends a Notice of Charge to Respondent, requests a position statement, and may conduct interviews, on-site visits, or subpoena documents under A.R.S. § 41-1481(C).
• Conciliation. Upon a finding of reasonable cause, ACRD attempts conciliation. A conciliation agreement may include reinstatement, back pay, policy changes, and a release. A.R.S. § 41-1481(F).
• Right to Sue and 90-day window. A Charging Party may request a Right to Sue letter at any time after the 90-day investigation window. Civil action must be filed within 90 days of receipt and in no event later than one year after the charge was filed. A.R.S. § 41-1481(D).
• Mediation. ACRD and EEOC both offer voluntary mediation. Mediation does not toll the 90-day right-to-sue window once issued, but tolls administrative timelines while pending.
• Confidentiality. Charge information is confidential under A.R.S. § 41-1481(M); unauthorized disclosure by ACRD personnel is a misdemeanor.
• Retaliation protection. Filing a charge is itself protected activity. Any adverse action taken because of the charge supports an independent retaliation claim under A.R.S. § 41-1464 and 42 U.S.C. § 2000e-3(a).

13. SOURCES AND REFERENCES

• A.R.S. § 41-1463 (Discrimination; unlawful practices) — https://www.azleg.gov/ars/41/01463.htm
• A.R.S. § 41-1481 (Filing charges; investigation; right to sue) — https://www.azleg.gov/ars/41/01481.htm
• A.R.S. § 41-1491 et seq. (Fair Housing) — https://www.azleg.gov/ars/41/01491.htm
• A.R.S. § 41-1492 et seq. (Public accommodations and disability) — https://www.azleg.gov/ars/41/01492-02.htm
• Arizona Attorney General — Civil Rights Division — https://www.azag.gov/civil-rights
• ACRD Civil Rights FAQ — https://www.azag.gov/civil-rights/faq
• ACRD Civil Rights Pamphlet — https://www.azag.gov/civil-rights/pamphlet
• ACRD Civil Rights Laws overview — https://www.azag.gov/civil-rights/discrimination/civil-rights-laws
• EEOC — How to File a Charge — https://www.eeoc.gov/filing-charge-discrimination
• EEOC Worksharing Agreements (29 C.F.R. § 1601.13) — https://www.ecfr.gov/current/title-29/subtitle-B/chapter-XIV/part-1601
• National Railroad Passenger Corp. v. Morgan, 536 U.S. 101 (2002) (continuing-violation doctrine)
• HUD Fair Housing Assistance Program — https://www.hud.gov/program_offices/fair_housing_equal_opp/partners/FHAP

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. Filing deadlines under ACRA and Title VII are strict and jurisdictional. An attorney licensed in Arizona must review and customize this Charge before submission. Confirm the current ACRD intake portal address, filing fee status, and EEOC dual-filing protocol before filing.