New Jersey Division on Civil Rights (DCR) Verified Complaint / Charge of Discrimination

VERIFIED COMPLAINT — NEW JERSEY DIVISION ON CIVIL RIGHTS

TABLE OF CONTENTS

1. Caption
2. Complainant Information
3. Respondent Information
4. Type of Discrimination Alleged
5. Protected Class(es) — Basis of Discrimination
6. Jurisdictional Facts
7. Statement of Particulars (Facts)
8. Causes of Action
9. Election of Remedies and Dual Filing
10. Relief Requested
11. Verification
12. Authorization, Privacy, and Service Information
13. Filing Instructions
14. New Jersey Practice Notes
15. Sources and References

1. CAPTION

STATE OF NEW JERSEY

OFFICE OF THE ATTORNEY GENERAL

DIVISION ON CIVIL RIGHTS

P.O. Box 089, Trenton, NJ 08625-0089

DCR Docket No. (assigned by Division): [________________________________]

EEOC Charge No. (if dual filed): [________________________________]

VERIFIED COMPLAINT OF DISCRIMINATION

2. COMPLAINANT INFORMATION

2.1. Name: [FIRST] [MIDDLE] [LAST]

2.2. Date of Birth: [__/__/____]

2.3. Home Address: [STREET, CITY, NJ ZIP]

2.4. Telephone (primary): [________]

2.5. Telephone (alternate): [________]

2.6. Email Address: [________]

2.7. Preferred Method of Contact: ☐ Email ☐ Telephone ☐ Mail

2.8. Language Access Needs: ☐ None ☐ Interpreter required: [LANGUAGE] ☐ Written translation required: [LANGUAGE]

2.9. Reasonable Accommodation Needs (DCR process): [DESCRIBE OR "NONE"]

2.10. Counsel (if any): [ATTORNEY NAME, FIRM, PHONE, EMAIL, NJ BAR ID] ☐ Pro se

3. RESPONDENT INFORMATION

3.1. Respondent Name: [BUSINESS / INDIVIDUAL / ENTITY]

3.2. Type of Respondent (check all that apply):

• ☐ Employer
• ☐ Labor organization / Union
• ☐ Employment agency
• ☐ Place of public accommodation
• ☐ Housing provider / Landlord / Real estate broker
• ☐ Lender / Credit provider
• ☐ State or local government entity
• ☐ Educational institution
• ☐ Other: [________]

3.3. Respondent Address: [STREET, CITY, STATE ZIP]

3.4. Respondent Telephone: [________]

3.5. Approximate Number of Employees (if employer): [________]

3.6. Individual(s) Allegedly Responsible (name, title, role):

• [NAME, TITLE];
• [NAME, TITLE];
• [NAME, TITLE].

4. TYPE OF DISCRIMINATION ALLEGED

4.1. Area of Discrimination (check all that apply):

• ☐ Employment
• ☐ Housing
• ☐ Public accommodation
• ☐ Credit / Lending
• ☐ Real estate / Brokerage
• ☐ Source of lawful income (housing)
• ☐ Family Leave (NJFLA)
• ☐ Other: [________]

4.2. Adverse Action(s) Taken (check all that apply):

• ☐ Failure to hire
• ☐ Failure to promote
• ☐ Discharge / Termination
• ☐ Constructive discharge
• ☐ Demotion
• ☐ Discipline / Suspension
• ☐ Layoff
• ☐ Pay disparity / Compensation discrimination
• ☐ Denial of training
• ☐ Denial of reasonable accommodation (disability / religion / pregnancy / breastfeeding)
• ☐ Harassment / Hostile environment
• ☐ Retaliation
• ☐ Refusal to rent / sell / lease housing
• ☐ Different terms or conditions in housing
• ☐ Refusal of service / goods / facilities (public accommodation)
• ☐ Refusal to make reasonable modifications (housing / accommodation)
• ☐ Steering / Discriminatory advertisements
• ☐ Other: [________]

5. PROTECTED CLASS(ES) — BASIS OF DISCRIMINATION

5.1. The discrimination alleged was based on (check all that apply, per N.J.S.A. § 10:5-12):

• ☐ Race
• ☐ Creed / Religion
• ☐ Color
• ☐ National origin
• ☐ Nationality
• ☐ Ancestry
• ☐ Age (40+ for federal ADEA work-share; NJLAD has no minimum age)
• ☐ Sex
• ☐ Pregnancy / Childbirth / Related medical conditions
• ☐ Breastfeeding
• ☐ Affectional or sexual orientation
• ☐ Gender identity or expression
• ☐ Marital status
• ☐ Civil union status
• ☐ Domestic partnership status
• ☐ Familial status (housing)
• ☐ Disability (physical, mental, or perceived)
• ☐ Atypical hereditary cellular or blood trait
• ☐ Genetic information / Refusal to submit to genetic testing
• ☐ Liability for service in the Armed Forces
• ☐ Source of lawful income (housing)
• ☐ HIV / AIDS status (treated as disability)
• ☐ Retaliation for protected activity (opposition / participation)
• ☐ Aiding, abetting, inciting, compelling, or coercing discrimination
• ☐ Other (specify): [________]

6. JURISDICTIONAL FACTS

6.1. Date(s) of alleged discrimination: [FIRST DATE: __/__/____] through [MOST RECENT DATE: __/__/____]

6.2. Most recent or continuing act of discrimination: [__/__/____]

6.3. Continuing violation alleged? ☐ Yes ☐ No
If yes, describe the pattern/continuing nature in Section 7 below (see Shepherd v. Hunterdon Developmental Ctr., 174 N.J. 1 (2002)).

6.4. Filing within 180 days? ☐ Yes ☐ No
The DCR generally lacks jurisdiction over complaints filed more than 180 days after the alleged unlawful act (N.J.S.A. § 10:5-18), subject to continuing-violation and equitable-tolling exceptions.

6.5. Location of alleged discrimination: [ADDRESS / WORKSITE / FACILITY], [COUNTY], NJ

7. STATEMENT OF PARTICULARS (FACTS)

7.1. Background. Complainant began [employment / tenancy / patronage / interaction] with Respondent on or about [__/__/____] as [POSITION / ROLE / RELATIONSHIP] at [LOCATION].

7.2. Protected status. At all relevant times, Complainant [was / is / was perceived to be / was associated with someone] [STATE PROTECTED CHARACTERISTIC(S) — e.g., a Black woman; a transgender man; a person with a major depressive disorder requiring intermittent leave; pregnant; a Section 8 voucher holder; a member of the U.S. Army Reserve], which Respondent [knew / had reason to know] because [BASIS OF KNOWLEDGE].

7.3. Specific incidents (chronological):

• [__/__/____] — Incident 1: [Description: who did what, where, what was said, who witnessed it, what documents reflect it].
• [__/__/____] — Incident 2: [Description].
• [__/__/____] — Incident 3: [Description].
• [__/__/____] — Incident 4: [Description].

7.4. Comparators. Persons outside Complainant's protected class who were similarly situated and treated more favorably include:

• [NAME / TITLE / DESCRIPTION OF FAVORABLE TREATMENT];
• [NAME / TITLE / DESCRIPTION].

7.5. Adverse action. On or about [__/__/____], Respondent [ADVERSE ACTION]. Respondent stated the reason was [STATED REASON], which Complainant believes is pretextual because [FACTS SHOWING PRETEXT].

7.6. Reasonable accommodation (if applicable). On or about [__/__/____], Complainant requested the following accommodation: [REQUEST]. Respondent [denied / failed to engage in interactive process / unreasonably delayed / granted but later rescinded].

7.7. Protected activity / Retaliation (if applicable). Complainant engaged in protected activity by [INTERNAL COMPLAINT / EEOC OR DCR FILING / REQUEST FOR ACCOMMODATION / OPPOSITION TO UNLAWFUL CONDUCT] on [__/__/____]. Within [NUMBER] days, Respondent took the following retaliatory action(s): [DESCRIBE].

7.8. Witnesses with knowledge:

7.9. Supporting documents (attach as exhibits where available):

• ☐ Offer letter / employment contract
• ☐ Performance reviews
• ☐ Disciplinary records
• ☐ Termination notice / final paystub
• ☐ Internal complaint(s) / HR correspondence
• ☐ Emails / text messages / social media
• ☐ Photographs / videos
• ☐ Medical documentation (for accommodation / pregnancy / breastfeeding)
• ☐ Lease, rental application, or housing communications
• ☐ Other: [________]

7.10. Damages and harm suffered:

• Economic: lost wages of approximately $[________]; lost benefits; out-of-pocket medical expenses of $[________]; mitigation efforts including [JOB SEARCH, ALTERNATIVE HOUSING].
• Non-economic: emotional distress, anxiety, depression, sleep disturbance, humiliation, loss of professional reputation, [OTHER].
• Ongoing harm: [CURRENT IMPACT].

8. CAUSES OF ACTION

8.1. The conduct alleged constitutes one or more of the following violations of the New Jersey Law Against Discrimination, N.J.S.A. § 10:5-1 et seq.:

• ☐ Disparate treatment in violation of N.J.S.A. § 10:5-12(a) (employment) / § 10:5-12(f) (public accommodation) / § 10:5-12(g)–(h) (housing);
• ☐ Hostile work / housing / public accommodation environment in violation of N.J.S.A. § 10:5-12;
• ☐ Failure to provide reasonable accommodation (disability, religion, pregnancy, breastfeeding) in violation of N.J.S.A. § 10:5-12(s) and N.J.A.C. 13:13-2.5;
• ☐ Retaliation in violation of N.J.S.A. § 10:5-12(d);
• ☐ Aiding, abetting, inciting, compelling, or coercing discrimination in violation of N.J.S.A. § 10:5-12(e);
• ☐ Discriminatory advertising / steering in violation of N.J.S.A. § 10:5-12(c) / (h);
• ☐ Source of lawful income discrimination (housing) in violation of N.J.S.A. § 10:5-12(g) and (h);
• ☐ Violation of the New Jersey Family Leave Act, N.J.S.A. § 34:11B-1 et seq.;
• ☐ Other: [________].

9. ELECTION OF REMEDIES AND DUAL FILING

9.1. Complainant understands that under N.J.S.A. § 10:5-13, filing this verified complaint with the DCR generally precludes the simultaneous prosecution of a Superior Court action under the NJLAD on the same facts. Complainant further understands the holding of Aldrich v. Manpower Temp. Servs., 277 N.J. Super. 500 (App. Div. 1994), that a DCR matter may be withdrawn before final determination to permit a subsequent Superior Court action.

9.2. Complainant has not filed any other administrative complaint or civil action concerning the conduct alleged herein, except as follows: [NONE / DESCRIBE].

9.3. EEOC Dual Filing. Pursuant to the work-share agreement between the DCR and the U.S. Equal Employment Opportunity Commission ("EEOC") under 29 C.F.R. § 1601.13, Complainant requests that this complaint be dual-filed with the EEOC to preserve all parallel federal claims under Title VII (42 U.S.C. § 2000e et seq.), the ADA (42 U.S.C. § 12101 et seq.), the ADEA (29 U.S.C. § 621 et seq.), and GINA (42 U.S.C. § 2000ff et seq.) where applicable.

• ☐ Complainant elects dual filing with the EEOC.
• ☐ Complainant elects to file with DCR only.

9.4. HUD Dual Filing. For housing discrimination claims, Complainant [requests / does not request] dual filing with the U.S. Department of Housing and Urban Development under the Fair Housing Act, 42 U.S.C. § 3601 et seq.

10. RELIEF REQUESTED

10.1. Complainant requests that the DCR investigate this complaint, find probable cause, and award all relief authorized by N.J.S.A. § 10:5-17 and § 10:5-27, including but not limited to:

• Cease-and-desist order against further discrimination and retaliation;
• Reinstatement and/or restoration of housing or services;
• Back pay, front pay, and lost benefits;
• Compensatory damages, including for emotional distress, humiliation, and pain and suffering;
• Punitive damages where authorized;
• Affirmative-action remedies, including hiring/promotion, training, and policy reform;
• Statutory penalties (N.J.S.A. § 10:5-14.1a);
• Reasonable attorney's fees and costs (N.J.S.A. § 10:5-27.1);
• Such other relief as is just and proper.

11. VERIFICATION

I, [COMPLAINANT NAME], of full age, hereby certify, pursuant to N.J.S.A. § 10:5-14 and N.J.A.C. 13:4-3.1, that:

1. I have read the foregoing Verified Complaint of Discrimination;
2. The factual statements made herein are true based upon my personal knowledge, except as to those matters stated upon information and belief, which I believe to be true; and
3. I am aware that if any statement made herein is willfully false, I am subject to punishment for unsworn falsification under N.J.S.A. § 2C:28-3 and to dismissal of this complaint.

Signed under penalty of perjury this [____] day of [_______________], 20[____], at [CITY, NJ].

[________________________________]

[COMPLAINANT SIGNATURE]

[COMPLAINANT PRINTED NAME]

Sworn and subscribed before me this [____] day of [_______________], 20[____].

[________________________________]

Notary Public of New Jersey

(My Commission Expires: [_______________])

12. AUTHORIZATION, PRIVACY, AND SERVICE INFORMATION

12.1. Authorization to Investigate. Complainant authorizes the DCR to disclose this complaint and supporting information to Respondent, the EEOC, HUD, and other governmental agencies as necessary to investigate and resolve the matter. Complainant authorizes the DCR to obtain employment, housing, medical, and educational records relevant to this complaint, subject to applicable privacy protections.

12.2. Confidentiality. Complainant understands that Respondent will receive a copy of this verified complaint and that DCR investigations are not confidential as to the parties.

12.3. Service on Respondent. Pursuant to N.J.A.C. 13:4-4.1, the DCR will serve a copy of the verified complaint on Respondent at the address provided in Section 3.

12.4. Updates and Cooperation. Complainant agrees to keep the DCR informed of any changes in address, telephone, or email; to cooperate with the investigation; and to respond to DCR requests within the time limits set.

13. FILING INSTRUCTIONS

13.1. Online filing (preferred): Submit an intake form via the New Jersey Bias Investigation Access System (NJBIAS) at https://njbias.nj.gov. After intake interview, DCR will prepare a verified complaint based on the information you provide.

13.2. By telephone: Call 1-833-NJDCR4U (1-833-653-2748), Monday–Friday, 8:30 a.m.–4:30 p.m., to begin the intake process.

13.3. By mail: Mail this completed verified complaint to:

Division on Civil Rights

P.O. Box 089

Trenton, NJ 08625-0089

13.4. In person at a regional office (subject to current DCR availability):

• Newark Regional Office;
• Atlantic City Regional Office;
• Camden Regional Office;
• Paterson Regional Office;
• Trenton Regional Office.

13.5. General inquiries: (973) 648-2700.

13.6. Website: https://www.njoag.gov/dcr or https://www.nj.gov/oag/dcr.

13.7. Retain copies. Keep a complete copy of the filed complaint and all supporting documents for your records and for any subsequent Superior Court action.

14. NEW JERSEY PRACTICE NOTES

• 180-day filing deadline. Under N.J.S.A. § 10:5-18, a verified complaint must be filed with DCR within 180 days of the alleged unlawful act. The continuing-violation doctrine may extend reach for ongoing harassment (Shepherd v. Hunterdon Developmental Ctr., 174 N.J. 1 (2002)). The 180-day rule applies ONLY to the administrative path; the Superior Court direct-action SOL is two (2) years (Montells v. Haynes, 133 N.J. 282 (1993)).
• No exhaustion required for civil action. A complainant is not required to file with DCR before suing in Superior Court. Filing with DCR is purely elective.
• Election of remedies. Filing with DCR generally bars a parallel Superior Court NJLAD action on the same facts. Aldrich v. Manpower Temp. Servs., 277 N.J. Super. 500 (App. Div. 1994), permits withdrawal before DCR final determination to allow subsequent Superior Court suit. Choose forum strategically — DCR is no-cost but slower; Superior Court allows juries and uncapped damages immediately.
• EEOC work-share. DCR and EEOC have a § 1601.13 work-share agreement. A timely DCR filing is automatically deemed filed with the EEOC for parallel Title VII / ADA / ADEA / GINA claims, preserving the federal 90-day right-to-sue clock.
• DCR procedure overview. After intake (NJBIAS or phone), DCR prepares a verified complaint, serves Respondent, and assigns an investigator. Respondent files an Answer. The investigator may interview parties and witnesses, request documents, and conduct on-site visits. DCR may attempt voluntary mediation. After investigation, DCR issues a "Finding of Probable Cause" or "No Probable Cause" determination. Probable-cause cases proceed to public hearing before an Administrative Law Judge in the OAL or to the Superior Court at the Director's election.
• Rights at hearing. Complainants may be represented by counsel, present evidence and witnesses, and cross-examine Respondent's witnesses. The DCR Director issues the final agency decision; appeals lie to the Appellate Division.
• Damages available administratively. DCR may award compensatory damages, statutory penalties (N.J.S.A. § 10:5-14.1a), affirmative relief, and attorney's fees, but punitive damages are typically reserved for Superior Court. This is a key reason many practitioners prefer the direct civil-action route under N.J.S.A. § 10:5-13.
• Family Leave Act enforcement. DCR also enforces the New Jersey Family Leave Act (N.J.S.A. § 34:11B-1 et seq.). Use the same intake portal.
• Source of lawful income (housing). Effective protections under N.J.S.A. § 10:5-12(g) and (h) prohibit refusing to rent to Section 8 voucher holders or other lawful-income recipients — a uniquely robust state protection.
• Anti-retaliation. N.J.S.A. § 10:5-12(d) protects complainants and witnesses; report any post-filing retaliation to DCR immediately for an amended or supplemental charge.
• Withdrawal procedure. A complainant who decides to pursue Superior Court instead must submit a written withdrawal request to DCR before any final agency determination (consistent with Aldrich). DCR closures of "Administrative Closure" or "Withdrawal — Right to Sue" generally permit subsequent civil litigation; a "Finding of No Probable Cause" or other adjudication on the merits may have preclusive effect.

15. SOURCES AND REFERENCES

• New Jersey Division on Civil Rights (DCR): https://www.njoag.gov/about/divisions-and-offices/division-on-civil-rights-home/
• DCR — How to File a Complaint: https://www.njoag.gov/about/divisions-and-offices/division-on-civil-rights-home/learn-how-to-file-a-complaint/
• DCR — Division Investigations: https://www.njoag.gov/about/divisions-and-offices/division-on-civil-rights-home/dcr-resources/division-investigations/
• NJBIAS Online Intake Portal: https://njbias.nj.gov
• DCR Procedural Rules — N.J.A.C. Title 13, Chapter 4: https://www.nj.gov/lps/dcr/downloads/Final-Title-13-12.30.pdf
• New Jersey Law Against Discrimination (PDF, current text): https://www.nj.gov/oag/dcr/downloads/NJ-Law-Against-Discrimination-Most-Updated.pdf
• N.J.S.A. § 10:5-12 — Justia: https://law.justia.com/codes/new-jersey/title-10/section-10-5-12/
• N.J.S.A. § 10:5-13 (election of remedies) and § 10:5-14 (verified complaint) — FindLaw: https://codes.findlaw.com/nj/title-10-civil-rights/
• N.J.S.A. § 10:5-18 (180-day filing): https://law.justia.com/codes/new-jersey/title-10/
• New Jersey Civil Rights Act, N.J.S.A. § 10:6-2: https://law.justia.com/codes/new-jersey/title-10/section-10-6-2/
• Aldrich v. Manpower Temp. Servs., 277 N.J. Super. 500 (App. Div. 1994), certif. denied, 139 N.J. 442 (1995)
• Montells v. Haynes, 133 N.J. 282 (1993): https://law.justia.com/cases/new-jersey/supreme-court/1993/133-n-j-282.html
• Shepherd v. Hunterdon Developmental Ctr., 174 N.J. 1 (2002) (continuing violation)
• Lehmann v. Toys 'R' Us, Inc., 132 N.J. 587 (1993)
• Aguas v. State, 220 N.J. 494 (2015)
• Rendine v. Pantzer, 141 N.J. 292 (1995)
• EEOC / FEPA Work-Sharing Agreements — 29 C.F.R. § 1601.13: https://www.ecfr.gov/current/title-29/part-1601/section-1601.13
• DCR contact: P.O. Box 089, Trenton, NJ 08625-0089; (973) 648-2700; toll-free 1-833-NJDCR4U

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney licensed in New Jersey must review and customize this document before filing. DCR procedures and forms change; verify the current intake process and required attachments at https://www.njoag.gov/dcr before submitting.