Hawaii Civil Rights Commission (HCRC) Administrative Charge of Discrimination

CHARGE OF DISCRIMINATION — HAWAII CIVIL RIGHTS COMMISSION

STATE OF HAWAII
DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
HAWAII CIVIL RIGHTS COMMISSION

830 Punchbowl Street, Room 411
Honolulu, HI 96813
Telephone: (808) 586-8636 | Fax: (808) 586-8655
Website: https://labor.hawaii.gov/hcrc/

1. COMPLAINANT INFORMATION

2. RESPONDENT INFORMATION

Additional Respondents (if any):

3. STATUTORY BASIS OF CHARGE

I allege that Respondent has engaged in unlawful discriminatory practices under the following provisions of Hawaii law (check all that apply):

HRS Chapter 378 — Employment Practices:

• ☐ HRS § 378-2(a)(1)(A) — Discrimination in terms, conditions, or privileges of employment
• ☐ HRS § 378-2(a)(1)(B) — Failure to provide reasonable accommodation (disability / religion / pregnancy)
• ☐ HRS § 378-2(a)(2) — Retaliation
• ☐ HRS § 378-2(a)(3) — Aiding, abetting, inciting, compelling, or coercing discrimination
• ☐ HRS § 378-2.3 — Equal pay; pay-history inquiry violation
• ☐ HRS § 378-2.5 — Improper arrest/court-record pre-employment inquiry
• ☐ HRS § 378-32 — Lawful off-duty conduct
• ☐ HRS § 378-62 — Whistleblower retaliation

HRS Chapter 489 — Public Accommodations:

• ☐ HRS § 489-3 — Denial of full and equal enjoyment of public accommodation

HRS Chapter 515 — Housing / Real Property:

• ☐ HRS § 515-3 — Discriminatory practices in real property transactions

Federal (dual-filed with EEOC / HUD):

• ☐ Title VII (42 U.S.C. § 2000e-2)
• ☐ ADA Title I (42 U.S.C. § 12112) / Title III (42 U.S.C. § 12182)
• ☐ ADEA (29 U.S.C. § 623)
• ☐ Equal Pay Act (29 U.S.C. § 206(d))
• ☐ GINA (42 U.S.C. § 2000ff)
• ☐ Fair Housing Act (42 U.S.C. § 3604)

4. PROTECTED CHARACTERISTIC(S)

I was discriminated against because of the following protected characteristic(s) under HRS § 378-2 and/or HRS § 489-3 (check all that apply):

• ☐ Race: [specify — e.g., Native Hawaiian, Pacific Islander, Black, White, Asian, Multiracial]
• ☐ Color: [specify]
• ☐ Ancestry / National Origin: [specify — e.g., Filipino, Japanese, Chinese, Korean, Samoan, Tongan, Micronesian]
• ☐ Sex (including pregnancy, childbirth, related medical conditions, breastfeeding)
• ☐ Gender identity or expression
• ☐ Sexual orientation
• ☐ Age (specify): [__]
• ☐ Religion: [specify]
• ☐ Disability: [specify physical or mental impairment]
• ☐ Marital status
• ☐ Arrest and court record (HRS § 378-2.5)
• ☐ Credit history or credit report
• ☐ Reproductive health decision
• ☐ Domestic or sexual violence victim status
• ☐ Retaliation for protected activity
• ☐ Association with a member of a protected class
• ☐ Other (specify): [________________________________]

5. ADVERSE ACTION(S) / DISCRIMINATORY CONDUCT

The following adverse action(s) were taken against me (check all that apply):

• ☐ Termination / Discharge
• ☐ Constructive Discharge / Forced Resignation
• ☐ Failure to Hire
• ☐ Failure to Promote
• ☐ Demotion
• ☐ Discipline / Write-Up / Suspension
• ☐ Reduction in Hours / Pay
• ☐ Denial of Equal Pay
• ☐ Harassment / Hostile Work Environment
• ☐ Sexual Harassment
• ☐ Failure to Accommodate (disability / religion / pregnancy / breastfeeding)
• ☐ Retaliation for Protected Activity
• ☐ Denial of Service / Refusal of Goods (public accommodations)
• ☐ Refusal to Rent / Sell / Finance Housing
• ☐ Discriminatory Terms in Housing
• ☐ Other: [________________________________]

6. KEY DATES

7. STATEMENT OF PARTICULARS

A. Background.

7.1. I am a [GENDER / RACE / RELIGION / DISABILITY / OTHER PROTECTED CLASS DESCRIPTOR] and was hired by Respondent on [DATE] as a [POSITION TITLE] at the [LOCATION] facility, located at [ADDRESS].

7.2. At all times, I performed my duties satisfactorily and met or exceeded Respondent's legitimate performance expectations. [Cite performance reviews, awards, raises, or other indicia of good performance.]

7.3. Respondent employs [NUMBER] or more employees and is therefore an "employer" within the meaning of HRS § 378-1.

B. Discriminatory Conduct.

7.4. [Describe first discriminatory incident with date, place, actors, conduct, witnesses, and direct quotations.]

7.5. [Describe pattern or escalation of conduct over time.]

7.6. [Identify comparators who are not members of Complainant's protected class and were treated more favorably under similar circumstances.]

C. Protected Activity (if applicable).

7.7. On [DATE], I engaged in protected activity by [describe complaint to HR, supervisor, owner, EEO officer, HCRC, or EEOC; opposition to discriminatory practice; request for reasonable accommodation].

7.8. [Describe Respondent's awareness of the protected activity.]

D. Adverse Action.

7.9. On [DATE], [__] days/weeks after my protected activity, Respondent [describe adverse action — terminated, demoted, denied promotion, harassed, refused service, etc.].

7.10. The reason given by Respondent, if any, was [stated reason]. This reason is pretextual because [describe pretext indicia: shifting explanations, deviation from policy, temporal proximity, comparator evidence, statistical disparity, "smoking gun" statements, etc.].

E. Damages and Harm.

7.11. As a result of Respondent's conduct, I have suffered [lost wages, lost benefits, emotional distress, humiliation, anxiety, depression, medical expenses, reputational harm, loss of professional opportunities, etc.].

F. Witnesses.

G. Supporting Documents (attached or available upon request).

• ☐ Personnel file / employment contract / offer letter
• ☐ Pay stubs / W-2s / 1099s / commission statements
• ☐ Performance reviews / disciplinary records
• ☐ Internal complaints / HR correspondence
• ☐ Email / text / Slack / Teams messages
• ☐ Witness statements
• ☐ Audio / video recordings (where lawful under HRS § 711-1111)
• ☐ Medical records (for disability or accommodation claims)
• ☐ Photographs of conduct or premises
• ☐ Termination notice / separation agreement
• ☐ Other: [________________________________]

8. RELIEF SOUGHT

I respectfully request that the Hawaii Civil Rights Commission investigate this charge and order such relief as is appropriate under HRS § 368-17 and HRS § 378-5, including:

• ☐ Reinstatement to position with full seniority and benefits
• ☐ Back pay with pre-judgment interest
• ☐ Front pay in lieu of reinstatement
• ☐ Compensatory damages (no statutory cap under Hawaii law)
• ☐ Punitive damages (no statutory cap under Hawaii law)
• ☐ Reasonable accommodation
• ☐ Cease-and-desist order
• ☐ Injunctive relief prohibiting further discrimination
• ☐ Posting of HCRC notice in workplace
• ☐ Anti-discrimination policy revision and training
• ☐ Expungement of negative personnel records
• ☐ Reasonable attorney's fees, expert witness fees, and costs (HRS § 368-17)
• ☐ Civil penalties under HRS § 489-8 (public accommodations cases)
• ☐ Notice of Right to Sue (HRS § 368-12) at the appropriate time
• ☐ Other: [________________________________]

9. DUAL-FILING WITH EEOC / HUD

• ☐ I request that this charge be DUAL-FILED with the United States Equal Employment Opportunity Commission ("EEOC") under 29 C.F.R. § 1601.13 and the EEOC-HCRC work-share agreement to preserve my federal rights under Title VII, the ADA, the ADEA, the Equal Pay Act, and/or GINA. I understand that the federal filing deadline is 300 days from the last discriminatory act for charges dual-filed with a deferral state agency.

• ☐ For housing claims, I request DUAL-FILING with the U.S. Department of Housing and Urban Development ("HUD") under the Fair Housing Act (42 U.S.C. § 3601 et seq.).

• ☐ I do NOT wish to dual-file at this time and elect to proceed only under Hawaii law.

10. PRIOR CHARGES / RELATED ACTIONS

Have you previously filed any charge, complaint, or lawsuit relating to the matters alleged herein?

• ☐ No
• ☐ Yes — Provide details:

11. VERIFICATION AND SIGNATURE

I, [COMPLAINANT NAME], having been duly sworn upon oath, depose and say that I have read the foregoing Charge of Discrimination, that I am the Complainant herein, and that the foregoing statements are true and correct to the best of my knowledge, information, and belief. I declare under penalty of perjury under the laws of the State of Hawaii that the foregoing is true and correct.

Date: [__/__/____]

[________________________________]

[COMPLAINANT NAME], Complainant

STATE OF HAWAII

COUNTY OF [___________________]

Subscribed and sworn to (or affirmed) before me this [____] day of [_______________], 20[____], by [COMPLAINANT NAME], who is personally known to me or produced [FORM OF IDENTIFICATION] as identification.

[________________________________]

Notary Public, State of Hawaii

Print Name: [NOTARY NAME]

My Commission Expires: [__/__/____]

(NOTARY SEAL)

12. ATTORNEY INFORMATION (if represented)

13. FILING INSTRUCTIONS

By Mail or Hand Delivery:

Hawaii Civil Rights Commission
830 Punchbowl Street, Room 411
Honolulu, HI 96813

By Telephone (Intake): (808) 586-8636
By Fax: (808) 586-8655
By Email / Online Intake: See https://labor.hawaii.gov/hcrc/

Pre-Complaint Questionnaire (PCQ): The HCRC standard intake process begins with a Pre-Complaint Questionnaire. The PCQ is reviewed by an intake investigator who will then assist with drafting and filing the verified Charge of Discrimination. Completing this template at intake accelerates the PCQ-to-charge process.

Neighbor Island filings: Complainants on Maui, Hawaii, Kauai, Molokai, or Lanai may file by mail, by phone intake, or through the HCRC's online intake portal. The HCRC may schedule remote interviews via teleconference.

14. HAWAII PRACTICE NOTES

• 180-day deadline (state). HRS § 368-11(c)(1) requires the charge to be filed within 180 days of the last discriminatory act. The "continuing-violation" doctrine may extend the period in pattern or hostile-environment cases, but do not rely on it where individual discrete acts can be timely charged.
• 300-day deadline (federal dual-filed). Hawaii is a "deferral state," so charges dual-filed with the EEOC under 42 U.S.C. § 2000e-5(e)(1) benefit from a 300-day federal deadline. The HCRC-EEOC work-share agreement deems EEOC charges automatically dual-filed where both jurisdictions cover the protected category. Confirm dual-filing in writing.
• One-employee threshold. HRS § 378-1 covers employers with one or more employees — the broadest threshold among state and federal civil rights statutes. Hawaii state coverage may apply where Title VII and the ADA do not.
• Hawaii-specific protected categories. HRS § 378-2 protects categories not covered by federal law: arrest and court record (HRS § 378-2.5); credit history; reproductive health decisions; domestic or sexual violence victim status; gender identity or expression (express); and breastfeeding. Public accommodations under HRS § 489-3 protect race, sex (including gender identity/expression), sexual orientation, color, religion, ancestry, and disability (including service animals).
• Notice of Right to Sue. Under HRS § 368-12, the HCRC issues a Notice of Right to Sue (a) at the request of the complainant after the lapse of statutory time periods, or (b) upon a determination of insufficient evidence. The complainant has 90 DAYS from receipt to file a civil action. CALENDAR THIS DATE.
• No damages cap. HRS § 368-17 and § 378-5 authorize compensatory and punitive damages without statutory cap, plus reasonable attorney's fees and costs.
• Investigation process. After filing, an HCRC investigator gathers evidence from both parties and may offer mediation or conciliation. The Executive Director either issues a Notice of Right to Sue (insufficient evidence) or a Reasonable Cause determination (which leads to conciliation and, if unsuccessful, an administrative hearing or referral to the HCRC's litigation unit).
• Confidentiality. HCRC charge files are generally confidential during investigation but may be shared with the EEOC, HUD, and other federal partners under work-share agreements.
• Retaliation is independently actionable. Adverse action taken because the complainant filed an HCRC charge or assisted another's charge is itself a violation of HRS § 378-2(a)(2); document and report any retaliatory conduct promptly.
• Toll the civil statute of limitations. Filing the HCRC charge does not toll the statute of limitations for any non-Chapter 378 civil claim (e.g., common-law wrongful discharge, intentional infliction of emotional distress). File those claims independently if necessary.

15. SOURCES AND REFERENCES

• Hawaii Civil Rights Commission — https://labor.hawaii.gov/hcrc/
• HCRC FAQs — https://labor.hawaii.gov/hcrc/faqs/
• HCRC Find a Law — https://labor.hawaii.gov/hcrc/find-a-law/
• HRS § 368-11 (Complaint against unlawful discrimination) — https://www.capitol.hawaii.gov/hrscurrent/Vol07_Ch0346-0398/HRS0368/
• HRS § 368-12 (Notice of right to sue) — https://www.capitol.hawaii.gov/hrscurrent/Vol07_Ch0346-0398/HRS0368/
• HRS Chapter 378 (Employment Practices) — https://www.capitol.hawaii.gov/hrscurrent/vol07_ch0346-0398/HRS0378/
• HRS § 378-2 — https://www.capitol.hawaii.gov/hrscurrent/vol07_ch0346-0398/HRS0378/HRS_0378-0002.htm
• HRS Chapter 489 (Public Accommodations) — https://www.capitol.hawaii.gov/hrscurrent/vol11_ch0476-0490/hrs0489/
• HRS Chapter 515 (Fair Housing) — https://www.capitol.hawaii.gov/hrscurrent/Vol12_Ch0501-0588/HRS0515/
• Hawaii Administrative Rules Title 12, Subtitle 9, Chapter 46 (HCRC Rules of Practice and Procedure) — https://labor.hawaii.gov/hcrc/find-a-law/hawaii-administrative-rules-1/
• HCRC Discrimination in Public Accommodations Flyer — https://labor.hawaii.gov/hcrc/files/2023/05/Discrimination-Public-Accommodations-Flyer-9.19.2023.pdf
• EEOC-FEPA Work-Share — https://www.eeoc.gov/employers/process
• EEOC Hawaii (Honolulu Local Office) — https://www.eeoc.gov/field-office/honolulu/location

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney licensed in Hawaii should review this charge before filing where the matter involves significant damages, complex legal theories, or parallel federal claims. Laws, citations, and agency procedures change frequently; verify all authorities and deadlines before filing.