APPLICATION FOR LEGAL REPRESENTATION FROM THE
DIRECTOR OF HUMAN RIGHTS PROCEEDINGS
Surname:
First names:
Mr, Mrs, Ms, Miss (delete those that do not apply)
Address:
Telephone (daytime):
Mobile:
Email:
Have you already been to the Human Rights Commission?
Yes
No
If you answered “No” then you need to do so before this Office can deal with
your application.
Did you receive a final letter or report from the Human Rights Commission?
Yes
No
(If yes, please attach a copy)
To assist with processing your application please complete the following
pages setting out brief details of what your complaint is about.
Before doing so, please understand that this Office can only provide legal
representation for the purpose of taking legal proceedings in the Human
Rights Review Tribunal and the Tribunal can only hear cases alleging a
breach of the anti-discrimination provisions of the Human Rights Act 1993.
THE OFFICE OF HUMAN RIGHTS PROCEEDINGS CANNOT ASSIST YOU
WITH ANY OTHER MATTER EVEN IF THERE HAVE BEEN SERIOUS
CONSEQUENCES FOR YOU.
Due to the large number of applications for legal representation received by
this Office, if your application does not appear to involve an arguable breach
of the Human Rights Act, you will be advised of this and your application will
not be taken any further.
PLEASE DO NOT ENCLOSE ANY ORIGINAL DOCUMENTS WITH YOUR
APPLICATION.
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THERE ARE TWO PARTS OF THE HUMAN RIGHTS ACT WHICH MAY
APPLY TO YOUR COMPLAINT.
Please read the following carefully and answer all questions relevant to your
complaint so that we can decide whether it concerns an arguable breach of
the anti-discrimination provisions of the Human Rights Act.
We can provide some limited assistance to help you complete this form.
PART 1A
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Government agency and/or person or body performing a public
function you are complaining about:
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To check whether your case is covered by Part 1A of the Human
Rights Act you must be able to tick the boxes below:
Are you complaining about legislation or a policy or practice of the
Government, or a person or body performing a public function?
Does what you are complaining about involve legislation or a policy or
practice which treated you differently from another person or group?
Is the reason for the different treatment one (or more) of the prohibited
grounds of discrimination? These are: (Please tick at least one)
Sex
Marital status
Religious belief
Ethical belief
Race or colour
Ethnic or national origins
Disability
Age
Political opinion
Employment status
Family status
Sexual orientation
Did what happened result in disadvantage or harm to you?
Please explain:
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IF PART 1A DOES NOT APPLY TO YOUR COMPLAINT IT MIGHT BE
COVERED BY PART 2 OF THE HUMAN RIGHTS ACT.
PART 2
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Name(s) of person(s) and/or company you are complaining about:
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To check whether your case is covered by Part 2 of the Human Rights
Act you must be able to tick the boxes below:
(a)
Did something happen to you because of a prohibited ground of
discrimination? These are: (Please tick at least one)
Sex
Marital status
Religious belief
Ethical belief
Race or colour
Ethnic or national origins
Disability
Age
Political opinion
Employment status
Family status
Sexual orientation
(b)
Did what you are complaining about happen in one of the areas of life
covered by Part 2 of the Human Rights Act? These are: (Please tick
at least one)
Employment (including pre-employment)
Partnerships
Industrial and professional associations, qualifying bodies and
vocational training bodies
Access to public places, vehicles and facilities
Provision of goods and services
Provision of land, housing and other accommodation
Access to educational establishments
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PART 2 ALSO COVERS: (Please tick if applicable)
Sexual harassment
Racial harassment
Racial disharmony
Victimisation
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Please briefly explain what happened to you:
What harm was caused to you? Please explain:
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Finally, please fill out the form overleaf to authorise us to obtain copies
of documents from your complaint file held by the Human Rights
Commission.
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I ………………………………………………………………………… (print name)
authorise the Human Rights Commission to provide copies of all information
gathered relating to my complaint, pursuant to section 82 of the Human Rights
Act 1993, to the Director of Human Rights Proceedings.
……………………………………………. (your usual signature)
Date:
Please tick one of the following boxes:
Yes, I consent to a copy of the Director’s decision about representation
being provided to the Disputes Resolution Team/Human Rights
Commission for training and education purposes.
No, I do not consent to the release of the Director’s decision about
representation to any other person.
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