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 — Cal. Gov. Code § 12940, § 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    ☐ Citizenship / Immigration Status (housing only via Unruh)
• ☐ 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
• ☐ Whistleblower retaliation (Cal. Lab. Code § 1102.5)    ☐ 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:

This charge is timely filed under Cal. Gov. Code § 12960(e), which provides a three-year statute of limitations for filing administrative complaints with the California Civil Rights Department, as amended by AB 9 (Reyes, 2019), effective January 1, 2020. The most recent act of discrimination occurred on [DATE], which is fewer than three (3) years before the filing of this charge. [For continuing-violation theories: The pattern of conduct continued through [DATE], such that all acts within the statutory period are timely under Richards v. CH2M Hill, Inc., 26 Cal. 4th 798 (2001) and acts before the period are timely as part of a single continuing course of conduct.]

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)
• ☐ Statutory damages under Cal. Civ. Code § 52(b) (Bane / Ralph Acts — $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) under the work-sharing agreement between CRD and EEOC pursuant to 29 C.F.R. § 1601.13. Cross-filing preserves my federal claims under Title VII of the Civil Rights Act, the Age Discrimination in Employment Act, the Americans with Disabilities Act, the Equal Pay Act, and the Genetic Information Nondiscrimination Act. I understand that California is a deferral state and that my federal charge is timely if the cross-filing occurs within 300 days of the discriminatory act.

☐ 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. I understand that by requesting an immediate right-to-sue notice, the CRD will close my case without investigation, and I must file a civil action in California Superior Court within ONE (1) YEAR of the date of the right-to-sue notice (Cal. Gov. Code § 12965(c)(1)(C)).

☐ 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

• 3-YEAR FILING DEADLINE — UNIQUELY LONG. Cal. Gov. Code § 12960(e), as amended by AB 9 (Reyes, 2019, effective 1/1/2020), gives complainants three (3) years from the last discriminatory act to file the CRD charge. Before AB 9, the deadline was one (1) year (matching most state agencies). California's 3-year window is now uniquely long — most states allow only 180 or 300 days. Do not, however, sleep on the claim: witnesses fade, documents are lost, and the federal 300-day deferral-state EEOC window is unchanged.
• AB 9 is NOT retroactive. AB 9 explicitly does not revive lapsed claims (Cal. Gov. Code § 12960(e)(5)). Acts that were already time-barred under the old 1-year rule when AB 9 took effect on 1/1/2020 remain barred.
• 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 cases may proceed with an investigated case to administrative hearing OR receive a right-to-sue. Unruh, Bane, and Ralph Act claims do NOT require CRD exhaustion — they may be filed directly in court.
• One-year post-RTS deadline. After receipt of a right-to-sue notice, complainant has ONE (1) YEAR to file a civil action (Cal. Gov. Code § 12965(c)(1)(C)). Missing this deadline is fatal even where the underlying conduct is recent.
• Tolling during CRD investigation. Under Cal. Gov. Code § 12965(d)(1), the FEHA statute of limitations for civil action is tolled during the pendency of CRD's investigation. EEOC tolling is more limited.
• Work-share with EEOC. CRD and EEOC operate under a long-standing work-share agreement (29 C.F.R. § 1601.13). Filing with one is deemed filed with the other for overlapping claims. To preserve federal claims, request dual filing in Section 10 above. EEOC's 300-day deferral-state deadline still controls federal claims regardless of California's 3-year window.
• 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)).
• Class and pattern-or-practice claims. CRD may convert individual charges into pattern-or-practice investigations under Cal. Gov. Code § 12961. Pattern-or-practice findings can support broader injunctive relief and class-wide remedies.
• 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. Retaliation against a complainant for filing a CRD charge is itself a separate violation of FEHA and creates a new 3-year window from the retaliatory act.
• California-only protected categories. Several FEHA categories have no federal parallel: marital status, medical condition, sexual orientation (pre-Bostock clarity), gender identity / expression, military / veteran status, reproductive health decision-making, and primary language. Plead these under FEHA / Unruh and consider whether to omit a federal cross-filing.

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 (3-year administrative deadline; AB 9) — https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=12960.&lawCode=GOV
• Cal. Gov. Code § 12965 (right-to-sue, 1-year civil filing window) — 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-state work-share) — https://www.ecfr.gov/
• 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.