Wisconsin DWD-ERD Discrimination Complaint (Equal Rights Division Charge)

DISCRIMINATION COMPLAINT — WISCONSIN EQUAL RIGHTS DIVISION

1. ADDRESSEE / FILING

TO: State of Wisconsin

Department of Workforce Development

Equal Rights Division — [MADISON / MILWAUKEE OFFICE]

[Madison: P.O. Box 8928, Madison, WI 53708-8928 / Milwaukee: 819 N. 6th St., Room 723, Milwaukee, WI 53203]

FROM (Complainant): [FULL LEGAL NAME]

[STREET ADDRESS], [CITY, WI ZIP]

Telephone: [__________] | Email: [__________]

RE: Verified Complaint of Discrimination — [Wis. Stat. § 111.31 et seq. (employment) / § 106.50 (housing) / § 106.52 (public accommodations)]

ERD Case No.: [to be assigned]

Date: [__/__/____]

2. PARTIES

2.1. Complainant: [FULL LEGAL NAME], an individual residing at [ADDRESS], in [COUNTY] County, Wisconsin.

2.2. Respondent: [FULL LEGAL NAME OF EMPLOYER / HOUSING PROVIDER / PUBLIC ACCOMMODATION], a [corporation / LLC / sole proprietor / public entity], with its principal place of business at [ADDRESS], [COUNTY] County, Wisconsin.

2.3. Number of Employees / Units: Respondent [employed approximately ___ persons / owned/operated ___ housing units / operated a public place of accommodation] at all times relevant.

3. JURISDICTION OF ERD

3.1. Wis. Stat. § 111.39(1) authorizes the Department of Workforce Development to receive and investigate complaints of employment discrimination filed within 300 days of the alleged discriminatory act.

3.2. [For housing:] Wis. Stat. § 106.50(6) authorizes ERD to receive and investigate housing discrimination complaints; the complaint must be filed within one year of the violation under § 106.50(6)(b).

3.3. [For public accommodations:] Wis. Stat. § 106.52(4) authorizes ERD to receive and investigate public accommodation complaints.

3.4. Complainant elects the administrative remedy and acknowledges that, for employment claims, this is the EXCLUSIVE first-instance remedy. See Bachand v. Connecticut Gen. Life Ins. Co., 101 Wis. 2d 617, 305 N.W.2d 149 (Ct. App. 1981).

3.5. EEOC dual-filing: Complainant requests dual-filing with the U.S. Equal Employment Opportunity Commission under the ERD-EEOC work-share agreement for any claims under Title VII, the ADA, the ADEA, or the EPA. ☐ Yes ☐ No

4. PROTECTED CLASS / BASIS OF DISCRIMINATION

Complainant alleges discrimination on the basis of the following protected class(es) under Wis. Stat. § 111.321 (employment), § 106.50(2) (housing), or § 106.52(3) (public accommodations) (check all that apply):

Employment (§ 111.321):

☐ Age (40+) ☐ Race ☐ Creed (religion) ☐ Color ☐ Disability
☐ Marital status ☐ Sex (including pregnancy and gender identity per Wis. case law)
☐ Sexual orientation ☐ National origin ☐ Ancestry
☐ Arrest record ☐ Conviction record ☐ Military service
☐ Use or nonuse of lawful products off the employer's premises during nonworking hours
☐ Declining to attend a meeting or participate in any communication about religious or political matters
☐ Genetic testing (§ 111.372) ☐ Honesty testing (§ 111.37)
☐ Retaliation for opposition or participation (§ 111.322(3))

Housing (§ 106.50(2)):

☐ Sex ☐ Race ☐ Color ☐ Sexual orientation ☐ Disability
☐ Religion ☐ National origin ☐ Marital status ☐ Family status
☐ Status as a victim of domestic abuse, sexual assault, or stalking
☐ Lawful source of income ☐ Age ☐ Ancestry

Public Accommodations (§ 106.52(3)):

☐ Sex ☐ Race ☐ Color ☐ Creed ☐ Sexual orientation
☐ National origin ☐ Ancestry

5. DISCRIMINATORY ACTION ALLEGED

Complainant alleges that Respondent committed one or more of the following discriminatory actions (check all that apply):

Employment (§ 111.322):

☐ Refusal to hire or employ ☐ Termination/discharge
☐ Discrimination in compensation, terms, conditions, or privileges of employment
☐ Refusal to promote ☐ Demotion ☐ Harassment / hostile work environment
☐ Refusal to make reasonable accommodation (disability or religion)
☐ Retaliation for opposing discriminatory practice or filing/testifying
☐ Discriminatory reference / blacklisting ☐ Discriminatory advertising

Housing (§ 106.50(2m)):

☐ Refusal to rent / sell / finance ☐ Different terms, conditions, or privileges
☐ Steering ☐ Discriminatory advertising ☐ Refusal of reasonable accommodation
☐ Refusal of reasonable modification ☐ Harassment ☐ Retaliation

Public Accommodations:

☐ Denial of full and equal enjoyment ☐ Different terms / pricing
☐ Refusal of service ☐ Harassment ☐ Retaliation

6. STATEMENT OF FACTS

6.1. Complainant [describe employment / tenancy / patron status — start date, position/unit/visit date, etc.].

6.2. Complainant is a member of the protected class(es) identified in Section 4 above because [explain — race, age, disability diagnosis, religious affiliation, marital status, conviction record, etc.].

6.3. On or about [__/__/____], Respondent [describe specific discriminatory act with date, location, decisionmakers, and statements].

6.4. [Describe additional incidents in chronological order. Include direct evidence (statements, documents) and circumstantial evidence (comparators, deviations from policy, temporal proximity).]

6.5. [Identify comparators: similarly situated persons OUTSIDE the protected class who were treated more favorably — names, dates, treatment.]

6.6. [Describe Complainant's protected activity, if any — internal complaint, accommodation request, prior charge.]

6.7. [Describe retaliation, if any — adverse action following protected activity; date proximity; causal evidence.]

6.8. Respondent's stated reason(s) for the adverse action are pretextual because [shifting rationales, deviation from policy, inconsistencies, temporal proximity, statistical evidence].

6.9. The most recent discriminatory act occurred on [__/__/____], which is within 300 days of the date of this complaint, satisfying Wis. Stat. § 111.39(1) (or within one year under § 106.50(6)(b)).

7. INJURIES AND DAMAGES

7.1. As a direct and proximate result of Respondent's discriminatory conduct, Complainant has suffered:

• Lost wages and benefits of approximately $[amount] through the date of this complaint, with continuing accrual;
• [For housing/public accommodations:] Out-of-pocket expenses, alternative housing/accommodation costs, emotional distress, humiliation;
• Loss of professional reputation and career opportunity;
• Emotional distress, humiliation, anxiety, and related mental-health impacts (note: NOT recoverable under WFEA per Bachand; recoverable under § 106.50/§ 106.52).

8. RELIEF REQUESTED

Complainant requests that ERD investigate this complaint and, upon a finding of probable cause, certify the matter to a hearing under Wis. Stat. § 111.39(4) and grant the following relief:

For Employment (WFEA — Bachand-limited):

☐ Cease-and-desist order
☐ Reinstatement to former position with full seniority
☐ Back pay with interest from the date of the adverse action
☐ Front pay where reinstatement is impractical
☐ Out-of-pocket costs (e.g., insurance premiums, relocation)
☐ Reasonable attorney fees and costs under Wis. Stat. § 111.39(4)(c)
☐ Affirmative remedial action (training, policy changes, posting)

For Housing (§ 106.50) / Public Accommodations (§ 106.52):

☐ All of the above, PLUS
☐ Compensatory damages (including emotional distress)
☐ Punitive damages
☐ Civil forfeiture under § 106.50(6)(h) / § 106.52(4)(a)
☐ Make-whole relief (rental of unit, accommodation, etc.)

9. VERIFICATION

I, [COMPLAINANT FULL NAME], declare under penalty of perjury under the laws of the State of Wisconsin that the foregoing statements are true and correct to the best of my knowledge, information, and belief.

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

Signature: [________________________________]

[COMPLAINANT NAME]

10. NOTARY ACKNOWLEDGMENT (If Required by Form)

State of Wisconsin )

County of [___________] ) ss.

Subscribed and sworn to (or affirmed) before me on [__/__/____], by [COMPLAINANT NAME], who proved to me on the basis of [satisfactory identification / personal knowledge] to be the person whose name is subscribed to this instrument.

[________________________________]

Notary Public, State of Wisconsin

My Commission Expires: [__/__/____]

11. ATTACHMENTS / EVIDENCE LIST

☐ Form ERD-4206 (Discrimination Complaint — Fair Employment) [for employment]
☐ Form ERD-10240 (Housing Discrimination Complaint) [for housing]
☐ Termination notice / adverse-action letter (Exhibit A)
☐ Performance evaluations (Exhibit B)
☐ Comparator personnel data (Exhibit C)
☐ Email/text/document evidence of discriminatory statements (Exhibit D)
☐ Medical records / disability documentation (Exhibit E) [if applicable]
☐ Accommodation request and Respondent's response (Exhibit F) [if applicable]
☐ Internal complaint records (Exhibit G)
☐ EEOC charge / right-to-sue (if cross-filed) (Exhibit H)
☐ Photographs / surveillance / lease / receipts (Exhibit I)

12. CERTIFICATE OF SERVICE

I certify that on [__/__/____], I caused a copy of this complaint to be served upon the named Respondent at the address(es) listed in Section 2 by [U.S. Mail (certified, return receipt requested) / personal service], and the original to be filed with the Wisconsin Equal Rights Division at the address listed in Section 1.

[________________________________]

[COMPLAINANT or COUNSEL NAME]

13. WISCONSIN PRACTICE NOTES

• Filing deadline (employment). Wis. Stat. § 111.39(1): 300 days from the discriminatory act or knowledge thereof. "Filing" means physically received by ERD; mailing alone is insufficient. See LIRC ER Decision Digest § 711.
• Filing deadline (housing). Wis. Stat. § 106.50(6)(b): one year from the violation for ERD administrative complaints; one year for direct civil action in circuit court (tolled by parallel ERD proceeding).
• Filing deadline (public accommodations). Wis. Stat. § 106.52: file with ERD or in circuit court (one-year SOL for civil action).
• EEOC dual-filing. Wisconsin is a Title VII deferral state; ERD-EEOC work-share auto-dual-files Title VII, ADA, ADEA, and EPA charges. Mark the dual-filing box on Form ERD-4206.
• Process. Initial Determination → Conciliation → Hearing before ALJ → Proposed Decision → ERD Decision → Appeal to LIRC → Final LIRC order → Ch. 227 judicial review.
• Judicial review (Ch. 227). Final LIRC orders are reviewable by petition for review under Wis. Stat. § 227.52, filed within 30 days under § 227.53(1)(a)2., in the circuit court for the petitioner's county of residence or Dane County. Standard of review: substantial evidence (factual findings) and de novo for legal questions after Tetra Tech EC, Inc. v. DOR, 2018 WI 75.
• Damages limit (WFEA). Make-whole relief only — back pay, reinstatement, out-of-pocket costs, attorney fees. NO emotional-distress or punitive damages. Bachand v. Connecticut Gen. Life Ins. Co., 101 Wis. 2d 617 (Ct. App. 1981).
• Damages (housing/public accommodations). Direct civil actions under § 106.50/§ 106.52 permit compensatory damages, punitive damages, injunctive relief, costs, and attorney fees. Administrative ERD process under those statutes can also award make-whole relief, civil forfeiture, and fees.
• No retaliation. Wis. Stat. § 111.322(3) prohibits retaliation for filing a complaint, opposing a discriminatory practice, or testifying in a proceeding. Add a separate count if retaliation occurs after filing.
• Counsel. While not required to file with ERD, retaining a Wisconsin-licensed employment-discrimination attorney significantly improves outcomes, particularly at the ALJ-hearing stage.

14. SOURCES AND REFERENCES

• Wis. Stat. § 111.31 et seq. — https://docs.legis.wisconsin.gov/statutes/statutes/111/II
• Wis. Stat. § 111.321 — https://docs.legis.wisconsin.gov/statutes/statutes/111/II/321
• Wis. Stat. § 111.39 — https://docs.legis.wisconsin.gov/statutes/statutes/111/II/39
• Wis. Stat. § 111.395 — https://docs.legis.wisconsin.gov/statutes/statutes/111/II/395
• Wis. Stat. § 106.50 — https://docs.legis.wisconsin.gov/statutes/statutes/106/II/50
• Wis. Stat. § 106.52 — https://docs.legis.wisconsin.gov/statutes/statutes/106/III/52
• Wis. Stat. ch. 227 — https://docs.legis.wisconsin.gov/statutes/statutes/227
• Form ERD-4206 — https://dwd.wisconsin.gov/dwd/forms/erd/erd-4206-e.htm
• DWD-ERD Civil Rights — https://dwd.wisconsin.gov/er/civilrights/
• DWD-ERD How to File a Civil Rights Complaint — https://dwd.wisconsin.gov/er/civilrights/complaint.htm
• LIRC ER Decision Digest — https://lirc.wisconsin.gov/erdigest/
• Bachand v. Connecticut Gen. Life Ins. Co., 101 Wis. 2d 617, 305 N.W.2d 149 (Ct. App. 1981)
• Tetra Tech EC, Inc. v. DOR, 2018 WI 75 (de novo review of agency legal interpretations)

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. The Wisconsin Fair Employment Act provides NO private right of action in court — administrative filing with DWD-ERD is the EXCLUSIVE first-instance remedy for employment discrimination, with judicial review limited to Ch. 227 review of LIRC final orders. Verify current ERD addresses, forms, and procedures before filing. A Wisconsin-licensed attorney should review this filing.