California Civil Rights Department (CRD) Administrative Charge of Discrimination

CALIFORNIA CIVIL RIGHTS DEPARTMENT (CRD) — ADMINISTRATIVE CHARGE OF DISCRIMINATION

TABLE OF CONTENTS

1. Submission Cover Information
2. Complainant Information
3. Respondent Information
4. Basis (Protected Characteristics)
5. Issues / Adverse Actions
6. Date(s) of Harm and Timeliness Statement
7. Statement of Particulars (Narrative)
8. Witnesses and Evidence
9. Damages and Relief Requested
10. EEOC Dual-Filing Election
11. Right-to-Sue Election
12. Verification and Signature
13. Attachments and Supporting Documents
14. Service / Filing Instructions
15. California Practice Notes
16. Sources and References

1. SUBMISSION COVER INFORMATION

2. COMPLAINANT INFORMATION

3. RESPONDENT INFORMATION

4. BASIS (PROTECTED CHARACTERISTICS)

I allege discrimination, harassment, or retaliation based on the following protected characteristic(s) under California law (check all that apply):

FEHA Employment / Housing — match the claim to Cal. Gov. Code § 12940 or § 12955:

• ☐ Race    ☐ Color    ☐ Religion / Religious Creed    ☐ National Origin    ☐ Ancestry
• ☐ Physical Disability    ☐ Mental Disability    ☐ Medical Condition    ☐ Genetic Information
• ☐ Marital Status    ☐ Sex (incl. pregnancy/childbirth)    ☐ Gender    ☐ Gender Identity    ☐ Gender Expression
• ☐ Age (40+)    ☐ Sexual Orientation    ☐ Veteran or Military Status
• ☐ Reproductive Health Decision-making
• ☐ Source of Income (housing)    ☐ Familial Status (housing)

Unruh Civil Rights Act — Cal. Civ. Code § 51:

• ☐ Race    ☐ Color    ☐ Religion    ☐ Ancestry    ☐ National Origin    ☐ Disability
• ☐ Medical Condition    ☐ Genetic Information    ☐ Marital Status    ☐ Sex
• ☐ Sexual Orientation    ☐ Citizenship    ☐ Primary Language    ☐ Immigration Status

Retaliation / Other:

• ☐ Retaliation for opposing discrimination    ☐ Retaliation for participating in protected activity
• ☐ Retaliation for requesting reasonable accommodation    ☐ Retaliation for reporting harassment
• ☐ Association with member of protected class

5. ISSUES / ADVERSE ACTIONS

I allege the following adverse action(s) (check all that apply):

Employment:

• ☐ Failure to hire    ☐ Termination / discharge    ☐ Layoff    ☐ Demotion    ☐ Failure to promote
• ☐ Denial of pay raise / unequal pay    ☐ Reduction in hours    ☐ Constructive discharge
• ☐ Discipline    ☐ Negative performance review    ☐ Harassment / hostile work environment
• ☐ Denial of reasonable accommodation    ☐ Denial of leave    ☐ Failure to engage in interactive process
• ☐ Retaliation    ☐ Failure to prevent discrimination/harassment (§ 12940(k))

Housing:

• ☐ Refusal to rent / sell    ☐ Eviction    ☐ Discriminatory terms    ☐ Steering / restricted access
• ☐ Discriminatory advertising    ☐ Denial of reasonable accommodation/modification    ☐ Harassment

Public Accommodation / Unruh:

• ☐ Denial of service    ☐ Differential / segregated service    ☐ Denial of disability access (ADA-coextensive)
• ☐ Discriminatory pricing    ☐ Refusal of admission    ☐ Removal from premises

Hate Violence / Ralph or Bane Act:

• ☐ Threats    ☐ Physical violence    ☐ Property damage    ☐ Intimidation / coercion to chill rights

6. DATE(S) OF HARM AND TIMELINESS STATEMENT

Timeliness Statement:

The alleged unlawful practice occurred on [DATE]. For the claim under [IDENTIFY STATUTE], the applicable administrative filing period under [§ 12960(e) / § 12980(b) / OTHER AUTHORITY] is [PERIOD], measured from [DATE], and the intake form is being filed on [DATE]. [If applicable, identify the facts and authority supporting an extension or a continuing-violation theory; do not assume that an older act is timely merely because related conduct continued.]

7. STATEMENT OF PARTICULARS (NARRATIVE)

I. Employment / Tenure / Patronage Background

7.1. I began [employment / tenancy / patronage] with Respondent on or about [DATE] as a [POSITION / CAPACITY].

7.2. At all relevant times, I was qualified for and performing my duties / fulfilling my obligations to Respondent's reasonable satisfaction.

7.3. I am a member of the following protected class(es): [PROTECTED CLASS(ES)].

II. Discriminatory Conduct

7.4. Beginning on or about [DATE], Respondent (through [DECISION-MAKER NAME / TITLE]) subjected me to the following discriminatory conduct:

• [INCIDENT 1 — date, location, persons involved, exact statements/conduct]
• [INCIDENT 2]
• [INCIDENT 3]

7.5. I was treated less favorably than similarly situated [employees / tenants / patrons] outside my protected class(es). Specifically: [COMPARATOR EVIDENCE].

III. Internal Complaint and Respondent's Response

7.6. On or about [DATE], I reported the discriminatory conduct to [HR / SUPERVISOR / MANAGER NAME] in [writing / orally / via email / via formal grievance].

7.7. Respondent [failed to investigate / conducted a sham investigation / found no violation / blamed me / took no remedial action].

7.8. After my complaint, Respondent retaliated against me by [ADVERSE RETALIATORY ACTS] on [DATE(S)].

IV. Pretext

7.9. Respondent's stated reason(s) for the adverse action — namely [STATED REASON] — are pretextual because:

• [Reason 1 — e.g., similarly situated employees outside my class engaged in the same conduct without adverse consequence];
• [Reason 2 — e.g., the stated reason was applied inconsistently / shifted over time];
• [Reason 3 — e.g., the timeline contradicts the stated reason].

V. Harm

7.10. As a direct result of the discrimination, I have suffered [economic harm — lost wages, lost benefits, out-of-pocket costs] and [non-economic harm — emotional distress, humiliation, anxiety, loss of dignity].

8. WITNESSES AND EVIDENCE

Documentary Evidence (attached or to be produced):

• ☐ Offer letter / employment contract
• ☐ Personnel file
• ☐ Performance reviews
• ☐ Pay stubs / W-2s
• ☐ Emails and text messages
• ☐ Internal complaint / HR communications
• ☐ Termination notice / separation agreement
• ☐ Medical records (for disability / accommodation claims)
• ☐ Accommodation request and response
• ☐ Comparator data
• ☐ Employee handbook / policies
• ☐ Audio / video recordings (where lawfully obtained — California is a two-party-consent state, Cal. Penal Code § 632)
• ☐ Other: [________________________________]

9. DAMAGES AND RELIEF REQUESTED

I seek the following relief through CRD investigation and/or subsequent civil action:

• ☐ Back pay and lost benefits from [DATE] to present
• ☐ Front pay / future lost earnings
• ☐ Reinstatement to my former position
• ☐ Promotion to the position I was wrongfully denied
• ☐ Reasonable accommodation: [DESCRIBE ACCOMMODATION]
• ☐ Removal of negative entries from personnel file
• ☐ Neutral letter of reference
• ☐ Compensatory damages for emotional distress and humiliation
• ☐ Statutory damages under Cal. Civ. Code § 52(a) (Unruh Act — minimum $4,000 per offense)
• ☐ Civil penalty under Cal. Civ. Code § 52(b)(2) for a separately alleged Ralph Act (§ 51.7) violation ($25,000)
• ☐ Punitive damages
• ☐ Reasonable attorney fees and costs (Cal. Gov. Code § 12965(c)(6); Cal. Civ. Code § 52(a))
• ☐ Injunctive relief — anti-discrimination training, policy reform, posting of notices
• ☐ Other: [________________________________]

10. EEOC DUAL-FILING ELECTION

☐ I REQUEST that this charge be cross-filed with the U.S. Equal Employment Opportunity Commission (EEOC) if current CRD and EEOC instructions or an agency-specific agreement provide for cross-filing of this covered claim. I request processing under that arrangement and the applicable filing and deferral procedures in 29 C.F.R. § 1601.13. Cross-filing does not by itself establish federal coverage or timeliness; confirm the governing statute, agency jurisdiction, current agreement or instructions, and actual EEOC filing.

☐ I DO NOT request EEOC cross-filing because my claims arise solely under California state law (e.g., Unruh Act for sexual-orientation discrimination, FEHA categories not paralleled under federal law, gender-identity claims pre-Bostock fact patterns, etc.).

EEOC Charge Number (if known): [________________________________]

11. RIGHT-TO-SUE ELECTION

For employment-related charges only (Cal. Gov. Code § 12965):

☐ I REQUEST AN IMMEDIATE RIGHT-TO-SUE NOTICE. For an employment complaint under Cal. Gov. Code § 12940, I understand that by requesting an immediate right-to-sue notice, the CRD will close my case without investigation, and the notice will state that I may bring a civil action within ONE (1) YEAR of its date, subject to applicable tolling (Cal. Gov. Code § 12965(c)(1)(D)-(E)).

☐ I REQUEST that the CRD investigate my charge and pursue conciliation, accusation, or referral as appropriate. I understand that I retain the right to request a right-to-sue notice at any time during the investigation.

12. VERIFICATION AND SIGNATURE

I, [COMPLAINANT NAME], declare under penalty of perjury under the laws of the State of California that the foregoing charge is true and correct to the best of my knowledge and belief, and that I have personal knowledge of the facts set forth herein except where stated upon information and belief.

Executed on [__/__/____] at [CITY], California.

Signature: [________________________________]

Printed Name: [COMPLAINANT NAME]

13. ATTACHMENTS AND SUPPORTING DOCUMENTS

The following documents are submitted with this charge:

• ☐ Exhibit A — Detailed timeline of events
• ☐ Exhibit B — Internal complaint and response
• ☐ Exhibit C — Termination / adverse action notice
• ☐ Exhibit D — Pay records
• ☐ Exhibit E — Performance reviews
• ☐ Exhibit F — Email / text correspondence
• ☐ Exhibit G — Witness statements / declarations
• ☐ Exhibit H — Medical records (if disability / accommodation involved)
• ☐ Exhibit I — Accommodation request and response
• ☐ Exhibit J — Photographs / video / audio (where lawful)
• ☐ Exhibit K — Comparator evidence
• ☐ Exhibit L — Employer handbook / anti-discrimination policy
• ☐ Other: [________________________________]

14. SERVICE / FILING INSTRUCTIONS

Method 1 — Online (Preferred):

Submit through the California Civil Rights System (CCRS) at https://calcivilrights.ca.gov/ by creating an account, completing the intake questionnaire, uploading this narrative as a supplemental attachment, and electronically signing.

Method 2 — Mail:

Print, sign, and mail to:

California Civil Rights Department
Attn: Intake Unit
2218 Kausen Drive, Suite 100
Elk Grove, CA 95758

Method 3 — Telephone Intake:

Call (800) 884-1684 (TTY: (800) 700-2320) Monday-Friday, 9:00 a.m. - 5:00 p.m. Pacific Time.

Method 4 — In-Person:

By appointment at the Elk Grove headquarters or any CRD regional office (Bakersfield, Fresno, Los Angeles, Oakland, Sacramento, San Diego, San Francisco, San Jose).

After filing: CRD will assign a charge number, may schedule a fact-finding conference, will serve a copy on Respondent (Cal. Gov. Code § 12962), and will conduct an investigation unless an immediate right-to-sue was requested. Complainant must update CRD with any change of address.

15. CALIFORNIA PRACTICE NOTES

• Choose the claim-specific filing period. Under current Cal. Gov. Code § 12960(e)(5), employment-practice complaints under § 12940 and Civil Code § 51.9 complaints generally have three years. A housing-discrimination complaint under Gov. Code § 12980(b) generally has one year. An administrative complaint alleging a violation of Civil Code §§ 51, 51.5, 51.7, 54, 54.1, or 54.2 generally has one year under § 12960(e)(1). Other listed claims have separate periods. Check the exact claim and any applicable extension under § 12960(e)(6); a federal EEOC filing period requires a separate calculation.
• Lapsed claims. Current § 12960(f)(3) says its civil-action tolling provision does not revive claims that have already lapsed. Calculate older claims under the law in effect for the relevant dates.
• AGENCY RENAME (2022). The Department of Fair Employment and Housing ("DFEH") was renamed the Civil Rights Department ("CRD") effective July 1, 2022 (SB 189 (2022)). All references in older case law and forms to "DFEH" now refer to the CRD.
• Right-to-sue mechanics. Employment cases require an administrative charge and right-to-sue notice before suit (Cal. Gov. Code § 12965). Housing complainants may use CRD’s investigation process or bring their own civil action without an employment-style right-to-sue notice. If CRD finds reasonable cause after investigating, it may file a lawsuit in court. Unruh, Bane, and Ralph Act claims may also be filed directly in court.
• Labor Code whistleblower retaliation. For a Cal. Lab. Code § 1102.5 claim, use the Labor Commissioner’s retaliation complaint process or evaluate a separate court claim; do not list that claim as a CRD charge basis.
• Employment right-to-sue period. For a complaint alleging an unlawful employment practice under § 12940, the CRD right-to-sue notice states a ONE (1) YEAR period from the notice date to bring a civil action (Cal. Gov. Code § 12965(c)(1)(D)-(E)); check statutory tolling and the period governing any other claim separately.
• Civil-action tolling after a CRD complaint. Under Cal. Gov. Code § 12960(f)(1), the time to file a civil action under a statute referenced in § 12960 is tolled from the filing of a CRD complaint alleging its violation until the department files a civil action or one year after the specified closure notice, with a separate rule for a timely closure appeal. Check any additional tolling under § 12965(e)-(f) and calculate a separate federal deadline for any EEOC claim.
• EEOC filing and deferral. Section 1601.13 supplies federal filing and FEPA-deferral mechanics and contemplates separate agency agreements; it is not itself a CRD-EEOC agreement. Confirm current agency instructions, federal coverage, agency jurisdiction over the alleged basis, and actual cross-filing. Any 300-day federal route is claim- and agency-specific and is not established merely by calling California a deferral state.
• Public-employer claims. Public employees must additionally comply with the Government Claims Act, Cal. Gov. Code § 910 et seq., for tort claims, but FEHA claims against public entities do NOT require a Government Claims Act notice (Garcia v. Los Angeles Unified Sch. Dist., 173 Cal. App. 3d 701 (1985)).
• Group or class complaints. Under Cal. Gov. Code § 12961, an aggrieved person or the director may file a representative complaint when the alleged practice similarly affects a group or class, or raises common questions. The director may treat a complaint investigated as a group or class complaint that way for conciliation, dispute resolution, or civil action when circumstances warrant.
• Prepare for fact-finding conference. CRD often convenes a fact-finding conference early in the investigation. Bring all documents, identify witnesses, and prepare a chronology. Statements made are not under oath but may be used in subsequent litigation.
• Confidentiality. Charge filings are not public until publicly accused or litigated. Settlement discussions during CRD mediation are confidential under Cal. Gov. Code § 12963.7.
• Retaliation for filing. Record any later retaliation as a separate alleged act and calculate its filing period under the statute governing that claim.
• Choose the governing claim. FEHA housing (§ 12955) and Unruh (§ 51(b)) list different protected bases. Primary language is listed in Unruh's business-establishment protections, but not in § 12955's housing list. Match the alleged act to the applicable statute before selecting an agency or federal cross-filing route.

16. SOURCES AND REFERENCES

• California Civil Rights Department — https://calcivilrights.ca.gov/
• CRD Complaint Process — https://calcivilrights.ca.gov/complaintprocess/
• California Civil Rights System (CCRS) Online Filing — https://ccrs.calcivilrights.ca.gov/
• Cal. Gov. Code § 12940 (FEHA unlawful practices) — https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=12940.&lawCode=GOV
• Cal. Gov. Code § 12960 (claim-specific administrative filing periods; current text from Legislative Counsel bulk code) — https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=12960.&lawCode=GOV
• Cal. Gov. Code § 12980(b) (housing-discrimination administrative filing period) — https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=12980.&lawCode=GOV
• Cal. Gov. Code § 12965(c)(1)(D)-(E) (employment right-to-sue, one-year civil filing period) — https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=12965.&lawCode=GOV
• AB 9 (Reyes, 2019) Stop Harassment and Reporting Extension Act — https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200AB9
• SB 189 (2022) — DFEH renamed CRD — https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB189
• 2 Cal. Code Regs. § 10005 et seq. (CRD regulations) — https://oal.ca.gov/
• Cal. Civ. Code § 51 (Unruh Civil Rights Act) — https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=51.&lawCode=CIV
• Cal. Civ. Code § 52 (Unruh remedies; $4,000 minimum) — https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=52.&lawCode=CIV
• 29 C.F.R. § 1601.13 (EEOC filing and FEPA deferral; agency agreements separate) — https://www.govinfo.gov/bulkdata/ECFR/title-29/ECFR-title29.xml
• EEOC Charge Filing Information — https://www.eeoc.gov/filing-charge-discrimination
• Richards v. CH2M Hill, Inc., 26 Cal. 4th 798 (2001) (continuing-violation doctrine)
• Pollock v. Tri-Modal Distribution Servs., Inc., 11 Cal. 5th 918 (2021) (FEHA accrual)
• Garcia v. Los Angeles Unified Sch. Dist., 173 Cal. App. 3d 701 (1985) (no GCA notice for FEHA)
• CRD Office (mailing address): 2218 Kausen Drive, Suite 100, Elk Grove, CA 95758
• CRD Phone: (800) 884-1684 / TTY: (800) 700-2320

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney licensed in California should review and customize this charge before submission. Laws, citations, agency procedures, and form requirements change frequently; verify current CRD intake procedures at calcivilrights.ca.gov before filing.