Massachusetts MCAD Charge of Discrimination (State Human Rights Agency Charge)

MASSACHUSETTS COMMISSION AGAINST DISCRIMINATION (MCAD) — CHARGE OF DISCRIMINATION

TABLE OF CONTENTS

1. Filing Information / Cover Sheet
2. Charging Party (Complainant) Information
3. Respondent (Employer / Other Entity) Information
4. Bases of Discrimination Asserted
5. Date(s) of Discrimination / Continuing Violation
6. Statement of Particulars
7. Damages and Relief Sought
8. Companion Claims and Dual-Filing
9. Verification (Sworn Signature)
10. Attachments and Exhibits Index
11. MCAD Filing and Service Instructions
12. Massachusetts Practice Notes
13. Sources and References

1. FILING INFORMATION / COVER SHEET

MASSACHUSETTS COMMISSION AGAINST DISCRIMINATION

☐ Boston Office — 1 Ashburton Place, 6th Floor, Suite 601, Boston, MA 02108 — (617) 994-6000

☐ Springfield Office — 436 Dwight Street, Room 220, Springfield, MA 01103 — (413) 739-2145

☐ Worcester Office — 100 Front Street, 6th Floor, Worcester, MA 01608 — (508) 453-9630

MCAD Docket No.: [ASSIGNED BY MCAD]

EEOC Charge No.: [ASSIGNED BY EEOC ON DUAL-FILING]

Date Filed: [__/__/____]

Filing Method: ☐ In-person ☐ Mail ☐ Virtual / Zoom intake ☐ Online intake

Charge Type: ☐ Employment ☐ Housing ☐ Public Accommodations ☐ Education ☐ Credit / Lending

2. CHARGING PARTY (COMPLAINANT) INFORMATION

3. RESPONDENT (EMPLOYER / OTHER ENTITY) INFORMATION

Additional Respondents (Individual Supervisors / Co-Respondents):

4. BASES OF DISCRIMINATION ASSERTED

I, the Charging Party, allege discrimination by Respondent on the basis of the following protected characteristics under G.L. c. 151B, § 4 and applicable federal law (mark all that apply):

☐ Race / Color (Title VII; G.L. c. 151B § 4(1); 42 U.S.C. § 1981)

☐ National Origin / Ancestry (Title VII; Ch. 151B § 4(1))

☐ Religion / Religious Creed (Title VII; Ch. 151B § 4(1A))

☐ Sex (including pregnancy and pregnancy-related conditions) (Title VII; Ch. 151B § 4(1) and § 4(11A); G.L. c. 151B § 105D — Pregnant Workers Fairness Act)

☐ Sexual Orientation (Ch. 151B § 4(1); Title VII per Bostock)

☐ Gender Identity (Ch. 151B § 4(1); Title VII per Bostock)

☐ Sexual Harassment / Hostile Work Environment (G.L. c. 151B § 4(16A); G.L. c. 214 § 1C)

☐ Age (40 or older) (Ch. 151B § 4(1B); ADEA, 29 U.S.C. § 623)

☐ Disability / Handicap — including failure to accommodate (Ch. 151B § 4(16); ADA, 42 U.S.C. § 12112)

☐ Genetic Information (Ch. 151B § 4(19); GINA, 42 U.S.C. § 2000ff)

☐ Military Service / Veteran Status (Ch. 151B § 4(17); USERRA)

☐ Retaliation for protected activity (Ch. 151B § 4(4) and (4A); Title VII § 704(a))

☐ Aiding and abetting (Ch. 151B § 4(5))

☐ Other (specify): [________________________________]

Type(s) of Adverse Action:

☐ Discharge / Termination ☐ Failure to Hire ☐ Failure to Promote ☐ Demotion ☐ Suspension ☐ Reduction of Hours ☐ Pay Disparity ☐ Discipline ☐ Constructive Discharge ☐ Hostile Work Environment ☐ Failure to Accommodate ☐ Denial of Leave ☐ Harassment ☐ Other: [________]

5. DATE(S) OF DISCRIMINATION / CONTINUING VIOLATION

5.1. Date of earliest discriminatory act: [__/__/____]

5.2. Date of most recent discriminatory act: [__/__/____]

5.3. ☐ Charging Party alleges a continuing violation under Cuddyer v. Stop & Shop Supermarket Co., 434 Mass. 521 (2001), and seeks consideration of all related conduct as part of an ongoing course of discriminatory or harassing conduct.

5.4. Timeliness Statement. This Charge is filed within 300 days of the most recent discriminatory act, in compliance with G.L. c. 151B, § 5. Calculation: [NUMBER OF DAYS] days have elapsed between the most recent act ([__/__/____]) and the filing date ([__/__/____]).

6. STATEMENT OF PARTICULARS

I, [CHARGING PARTY NAME], depose and state the following under oath:

6.1. Background. I am a [describe protected status — e.g., 52-year-old African-American woman; transgender man; person with multiple sclerosis]. I was employed by Respondent [EMPLOYER NAME] as a [JOB TITLE] from [__/__/____] until [__/__/____], at Respondent's [LOCATION] facility. My most recent annual salary was $[________], plus benefits.

6.2. Job performance. Throughout my employment, I performed my duties competently and met or exceeded Respondent's legitimate performance expectations. I received [describe positive reviews, raises, promotions, awards, customer commendations].

6.3. First discriminatory incident. On or about [__/__/____], [describe specific incident — who said/did what, to whom, in front of whom, where, and how it relates to your protected status]. Witness(es): [NAME(S)].

6.4. Pattern of discriminatory conduct. Following the [__/__/____] incident, I was subjected to a continuing course of discriminatory conduct, including:

a. [Date — Description — Witnesses];

b. [Date — Description — Witnesses];

c. [Date — Description — Witnesses].

6.5. Comparator evidence. Similarly situated employees outside my protected class — including [NAMES OR JOB TITLES] — were treated more favorably in that [describe disparate treatment, e.g., not disciplined for similar conduct, given more favorable assignments, paid more for equivalent work].

6.6. Internal complaint / protected activity. On or about [__/__/____], I engaged in protected activity by [reporting the discrimination to HR / supervisor / management; filing an internal complaint; refusing to participate in unlawful conduct; requesting a reasonable accommodation under the ADA / Pregnant Workers Fairness Act]. The complaint was made to [NAME / TITLE] [in writing / orally / via email]. [ATTACH AS EXHIBIT.]

6.7. Retaliation. Within [NUMBER] days of my protected activity, Respondent retaliated against me by [describe retaliatory acts — written discipline, schedule change, transfer, denial of promotion, termination].

6.8. Adverse action. On or about [__/__/____], Respondent [terminated my employment / demoted me / suspended me / forced me to resign by creating intolerable working conditions]. Respondent's stated reason was [________________________________], which is pretextual because [explain why the stated reason is false or insufficient — e.g., similarly situated employees were not disciplined; the stated rule was not previously enforced; the timing follows the protected activity].

6.9. Failure to accommodate (if applicable). [Describe disability / pregnancy / religious-practice basis. Identify the accommodation requested, the date requested, the manner of request, the interactive process (or absence thereof), and Respondent's response.]

6.10. Sexual harassment (if applicable). [Describe unwelcome sexual conduct, frequency, severity, identity of harasser, supervisory or co-worker status, employer notice, and remedial response (or absence). Cite G.L. c. 151B § 4(16A) and G.L. c. 214 § 1C.]

6.11. Damages. As a result of Respondent's unlawful conduct, I have suffered [lost wages and benefits in the amount of approximately $______; emotional distress including anxiety, depression, sleeplessness, humiliation; loss of professional reputation; out-of-pocket medical/counseling expenses of $______; loss of career opportunities].

6.12. Witnesses. The following individuals have personal knowledge of the matters alleged:

7. DAMAGES AND RELIEF SOUGHT

7.1. Charging Party seeks all relief available under G.L. c. 151B, § 9 and applicable federal law, including:

a. Back pay and benefits, with prejudgment interest;

b. Front pay or reinstatement to [his/her/their] former position with full seniority and benefits;

c. Compensatory damages for emotional distress, humiliation, and loss of enjoyment of life (uncapped under Ch. 151B);

d. Punitive damages on a showing of malice or reckless indifference (uncapped under Ch. 151B; subject to 42 U.S.C. § 1981a caps for federal claims);

e. Reasonable attorney's fees, expert witness fees, and costs;

f. Injunctive and equitable relief, including but not limited to anti-discrimination training, policy reform, and posting of MCAD-approved notices;

g. Such other relief as the Commission deems just and proper.

8. COMPANION CLAIMS AND DUAL-FILING

8.1. EEOC Dual-Filing. Pursuant to the MCAD/EEOC work-sharing agreement and 29 C.F.R. § 1601.13, this Charge shall be deemed simultaneously filed with the U.S. Equal Employment Opportunity Commission to preserve federal claims under:

☐ Title VII of the Civil Rights Act of 1964 (42 U.S.C. § 2000e et seq.)

☐ Americans with Disabilities Act (42 U.S.C. § 12101 et seq.)

☐ Age Discrimination in Employment Act (29 U.S.C. § 621 et seq.)

☐ Genetic Information Nondiscrimination Act (42 U.S.C. § 2000ff et seq.)

☐ Equal Pay Act (29 U.S.C. § 206(d))

8.2. MCRA Reservation (G.L. c. 12 §§ 11H/11I). Charging Party expressly reserves all rights to pursue separate civil litigation under the Massachusetts Civil Rights Act, which has no administrative-exhaustion requirement and reaches private actors regardless of state-actor status. The MCRA claim is not within MCAD jurisdiction.

8.3. Civil Court Removal. Charging Party reserves the right to withdraw this Charge after 90 days and pursue civil litigation under G.L. c. 151B, § 9 in Superior Court or U.S. District Court.

9. VERIFICATION (SWORN SIGNATURE)

I, [CHARGING PARTY NAME], swear or affirm under the pains and penalties of perjury that I have read the foregoing Charge of Discrimination, that I am the Charging Party, that the factual allegations are true based on my personal knowledge except where stated on information and belief, and that I have authority to file this Charge.

[________________________________]

[CHARGING PARTY NAME], Charging Party

Date: [__/__/____]

Subscribed and sworn to before me this [____] day of [_______________], 20[____].

[________________________________]

Notary Public / MCAD Authorized Officer

(My Commission Expires: [_______________])

10. ATTACHMENTS AND EXHIBITS INDEX

The following documents are attached and incorporated by reference:

☐ Exhibit A — Offer letter / employment contract

☐ Exhibit B — Job description / written performance expectations

☐ Exhibit C — Performance reviews

☐ Exhibit D — Internal complaint(s) / HR correspondence

☐ Exhibit E — Disciplinary documentation

☐ Exhibit F — Termination notice / separation paperwork

☐ Exhibit G — Comparator data (if available)

☐ Exhibit H — Email / text / message correspondence evidencing discrimination or retaliation

☐ Exhibit I — Medical / mental-health records (limited disclosure; consider seeking protective order at investigation stage)

☐ Exhibit J — Witness statements / declarations

☐ Exhibit K — Pay records / W-2s / paystubs

☐ Exhibit L — Reasonable accommodation request and Respondent's response (if applicable)

☐ Exhibit M — Other: [________________________________]

11. MCAD FILING AND SERVICE INSTRUCTIONS

11.1. In-Person Filing. Bring two (2) copies of the verified Charge and all attachments to the appropriate MCAD office. Bring photo identification. MCAD intake specialists will accept the filing, administer the oath if not already notarized, and provide a stamped copy.

11.2. Mail Filing. Mail the original signed and notarized Charge plus one copy and all attachments to the appropriate MCAD office. Use certified mail, return receipt requested, to document timely filing. The 300-day deadline runs to the date of MCAD receipt, NOT the postmark date — mail well in advance.

11.3. Virtual / Zoom Intake. Schedule a virtual intake interview at https://www.mass.gov/how-to/how-to-file-a-complaint-of-discrimination. The intake specialist will guide preparation and verification.

11.4. Online Intake. Complete the online intake form at https://www.mass.gov/info-details/file-a-complaint-of-discrimination-at-the-mcad to begin the process.

11.5. Service on Respondent. MCAD will serve a copy of the Charge on Respondent within ten (10) days of filing. 804 CMR 1.04(8). Charging Party need not effect service.

11.6. Respondent's Position Statement. Respondent must file a verified Position Statement within twenty-one (21) days of service. 804 CMR 1.05.

11.7. Investigation. MCAD will assign an investigator and may request additional information, conduct interviews, hold a fact-finding conference, and ultimately issue a Probable Cause or Lack of Probable Cause determination. 804 CMR 1.10–1.13.

12. MASSACHUSETTS PRACTICE NOTES

• 300-Day Deadline. Charges must be received by MCAD within 300 days of the last discriminatory act (G.L. c. 151B, § 5). This is longer than the 180-day federal floor and reflects Massachusetts's deferral-state status. Late charges are dismissed without prejudice to MCRA or other non-Ch. 151B claims with longer limitations periods.
• Continuing-Violation Doctrine. Hostile-work-environment and serial-violation theories may capture conduct outside the 300-day window so long as one act fell within the period and the acts are part of the same actionable hostile environment. Cuddyer v. Stop & Shop, 434 Mass. 521 (2001); Nat'l R.R. Passenger Corp. v. Morgan, 536 U.S. 101 (2002).
• Equitable Tolling / Good Cause. 804 CMR 1.04(4) permits filing beyond 300 days for "age, health, or other good cause." Tolling is narrow; document any reason carefully.
• Employer Coverage Threshold. Ch. 151B applies to employers with 6+ MA employees; verify by reviewing payroll records, public filings, or industry databases. Respondents below the threshold may still be reached via MCRA, common-law tort, or Title VII (15+).
• Verification Requirement. A charge must be verified under oath. 804 CMR 1.04(2)(b). Unsworn submissions may be amended within 300 days but are not deemed filed until verified.
• EEOC Dual-Filing — Automatic. Under the MCAD/EEOC work-sharing agreement, an MCAD charge stating a Title VII / ADA / ADEA / GINA basis is automatically dual-filed with the EEOC. Confirm dual-filing on the cover sheet to preserve federal claims and right-to-sue letter eligibility.
• 90-Day Removal to Court. A complainant may remove the case to Superior Court (or federal court for federal claims) any time after 90 days from filing, so long as the suit is filed within 3 years of the discriminatory act. G.L. c. 151B, § 9; Charland v. Muzi Motors, 417 Mass. 580 (1994).
• Probable Cause Determination. MCAD investigates and issues either a Probable Cause (PC) or Lack of Probable Cause (LOPC) finding. A PC finding triggers conciliation and, failing settlement, a public hearing before an MCAD Hearing Officer. An LOPC finding may be appealed to the full Commission within 10 days. 804 CMR 1.13.
• MCAD Damages Authority. MCAD may award lost wages, emotional distress damages (without statutory cap), affirmative relief, attorney's fees, and civil penalties. Damages awarded by MCAD have been sustained at significant levels; the agency is not a small-claims forum.
• MCRA Companion Claim. The MCRA (G.L. c. 12 §§ 11H/11I) is NOT within MCAD jurisdiction and need not be filed administratively. UNIQUE FEATURE: MCRA reaches private conduct (no state actor required) — the only such state civil rights statute in the country. Where the discriminatory conduct includes threats, intimidation, or coercion involving actual or threatened physical confrontation, file a parallel MCRA claim in court within 3 years.
• No Pre-Filing Counseling Requirement. Unlike some federal-sector procedures, Massachusetts requires no pre-charge counseling. The Charge itself initiates jurisdiction.
• Confidentiality. MCAD investigation files are not public record during the investigation. 804 CMR 1.21. After a public hearing, materials become part of the public record subject to limited exemptions.
• Withdrawal. A complainant may withdraw at any time. Withdrawal "with prejudice" forecloses re-filing on the same allegations; "without prejudice" preserves rights. Discuss with counsel.

13. SOURCES AND REFERENCES

• G.L. c. 151B, § 4 (Unlawful practices) — https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXI/Chapter151B/Section4
• G.L. c. 151B, § 5 (Procedure on filing complaint; 300-day deadline) — https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXI/Chapter151B/Section5
• G.L. c. 151B, § 9 (Civil action) — https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXXI/Chapter151B/Section9
• G.L. c. 12, § 11H (MCRA — AG enforcement) — https://malegislature.gov/Laws/GeneralLaws/PartI/TitleII/Chapter12/Section11H
• G.L. c. 12, § 11I (MCRA — private right of action) — https://malegislature.gov/Laws/GeneralLaws/PartI/TitleII/Chapter12/Section11I
• G.L. c. 214, § 1C (Sexual harassment) — https://malegislature.gov/Laws/GeneralLaws/PartIII/TitleI/Chapter214/Section1C
• 804 CMR 1.00 (MCAD Rules of Procedure) — https://www.mass.gov/doc/804-cmr-1-rules-of-procedure/download
• 804 CMR 3.00 (Employment Discrimination Guidelines) — https://www.mass.gov/doc/804-cmr-300-employment-discrimination/download
• MCAD homepage — https://www.mass.gov/mcad
• MCAD Complaint Filing — https://www.mass.gov/mcad-complaints-of-discrimination
• How to File a Complaint of Discrimination — https://www.mass.gov/how-to/how-to-file-a-complaint-of-discrimination
• Deadline for Filing a Complaint of Discrimination at the MCAD — https://www.mass.gov/info-details/deadline-for-filing-a-complaint-of-discrimination-at-the-mcad
• Guide to the MCAD Case Process — https://www.mass.gov/info-details/guide-to-the-mcad-case-process
• EEOC dual-filing regulation — 29 C.F.R. § 1601.13
• Cuddyer v. Stop & Shop Supermarket Co., 434 Mass. 521 (2001) (continuing violation)
• Charland v. Muzi Motors, Inc., 417 Mass. 580 (1994) (Ch. 151B exclusivity / removal)
• Bally v. Northeastern Univ., 403 Mass. 713 (1989) (MCRA threats/intimidation/coercion)
• Bell v. Mazza, 394 Mass. 176 (1985) (MCRA reaches private actors)
• College-Town Div. of Interco, Inc. v. MCAD, 400 Mass. 156 (1987) (employer vicarious liability)
• Haddad v. Wal-Mart Stores, Inc., 455 Mass. 91 (2009) (uncapped punitive damages under Ch. 151B)

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney licensed in Massachusetts must review and customize this document before filing. Statutes, regulations, and case law change frequently; verify all authorities before use. Filing deadlines are strict — confirm the 300-day window with counsel before submission.