Form AOC-CV-530 "Complaint for Civil No-Contact Order Pursuant to the Workplace Violence Prevention Act - Motion for Temporary No-Contact Order" - North Carolina

What Is Form AOC-CV-530?

This is a legal form that was released by the North Carolina District Court - a government authority operating within North Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2011;
  • The latest edition provided by the North Carolina District Court;
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  • Fill out the form in our online filing application.

Download a fillable version of Form AOC-CV-530 by clicking the link below or browse more documents and templates provided by the North Carolina District Court.

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Download Form AOC-CV-530 "Complaint for Civil No-Contact Order Pursuant to the Workplace Violence Prevention Act - Motion for Temporary No-Contact Order" - North Carolina

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File No.
STATE OF NORTH CAROLINA
In The General Court Of Justice
County
District Court Division
Name Of Petitioner /Employer
COMPLAINT FOR
Address Of Petitioner/ Employer
CIVIL NO-CONTACT ORDER
PURSUANT TO THE WORKPLACE
VIOLENCE PREVENTION ACT
VERSUS
Name And Address Of Respondent
MOTION FOR TEMPORARY
NO-CONTACT ORDER
G.S. 95-262
NOTE TO PETITIONER:
This Form is for use by employers only. If you are an individual that has been threatened, please refer to either the
"Complaint and Motion for Domestic Violence Protective Order," AOC-CV-303, or the "Complaint for No-Contact Order for
Stalking or Nonconsensual Sexual Conduct," AOC-CV-520. Check only the boxes below that apply and fill in blanks.
Additional sheets may be attached.
1.
The petitioner is an employer as defined by G.S. 95-260(2) in that:
a.
the petitioner is a person or entity that employs one or more employees.
b.
the petitioner is the State of North Carolina or one of its political subdivisions.
2.
The unlawful conduct occurred in this county.
3.
An employee of the petitioner has suffered unlawful conduct from the respondent and the unlawful conduct can be reasonably
construed to be carried out, or to have been carried out, at the employee's workplace. The unlawful conduct consisted of:
(Give
specific dates and describe in detail what happened.)
a.
T he respondent attempted to cause bodily injury or did intentionally cause bodily injury to the employee.
b.
The respondent willfully, and on more than one occasion, followed, was in the presence of, or otherwise harassed as
defined in G.S. 14-277.3A, the e mployee without legal purpose and with the intent to place the e mployee in reasonable
fear for the e mployee's safety.
c.
The respondent willfully threatened, orally, in writing or by any other means, to physically injure the e mployee in a manner
and under circumstances that would cause a reasonable person to believe that the threat was likely to be carried out and
that actually caused the e mployee to believe the threat would be carried out.
4.
The employee that is the subject of the unlawful conduct was consulted prior to the filing of this Complaint and Motion in order to
determine whether any safety concerns exist in relation to the employee's participation in the process.
(Over)
AOC-CV-530, New 7/11
© 2011 Administrative Office of the Courts
File No.
STATE OF NORTH CAROLINA
In The General Court Of Justice
County
District Court Division
Name Of Petitioner /Employer
COMPLAINT FOR
Address Of Petitioner/ Employer
CIVIL NO-CONTACT ORDER
PURSUANT TO THE WORKPLACE
VIOLENCE PREVENTION ACT
VERSUS
Name And Address Of Respondent
MOTION FOR TEMPORARY
NO-CONTACT ORDER
G.S. 95-262
NOTE TO PETITIONER:
This Form is for use by employers only. If you are an individual that has been threatened, please refer to either the
"Complaint and Motion for Domestic Violence Protective Order," AOC-CV-303, or the "Complaint for No-Contact Order for
Stalking or Nonconsensual Sexual Conduct," AOC-CV-520. Check only the boxes below that apply and fill in blanks.
Additional sheets may be attached.
1.
The petitioner is an employer as defined by G.S. 95-260(2) in that:
a.
the petitioner is a person or entity that employs one or more employees.
b.
the petitioner is the State of North Carolina or one of its political subdivisions.
2.
The unlawful conduct occurred in this county.
3.
An employee of the petitioner has suffered unlawful conduct from the respondent and the unlawful conduct can be reasonably
construed to be carried out, or to have been carried out, at the employee's workplace. The unlawful conduct consisted of:
(Give
specific dates and describe in detail what happened.)
a.
T he respondent attempted to cause bodily injury or did intentionally cause bodily injury to the employee.
b.
The respondent willfully, and on more than one occasion, followed, was in the presence of, or otherwise harassed as
defined in G.S. 14-277.3A, the e mployee without legal purpose and with the intent to place the e mployee in reasonable
fear for the e mployee's safety.
c.
The respondent willfully threatened, orally, in writing or by any other means, to physically injure the e mployee in a manner
and under circumstances that would cause a reasonable person to believe that the threat was likely to be carried out and
that actually caused the e mployee to believe the threat would be carried out.
4.
The employee that is the subject of the unlawful conduct was consulted prior to the filing of this Complaint and Motion in order to
determine whether any safety concerns exist in relation to the employee's participation in the process.
(Over)
AOC-CV-530, New 7/11
© 2011 Administrative Office of the Courts
Because Of These Acts Of Unlawful Conduct, The Petitioner Requests That The Court Grant The Following Relief:
(Check only boxes that apply.)
1.
A permanent no-contact order. (A permanent order cannot last longer than one year.)
2.
A temporary no-contact order. (A temporary order cannot last longer than ten days.)
The temporary order to be issued ex parte (without notice to the defendant) because the plaintiff will suffer immediate injury,
3.
loss, or damage before the defendant can be heard in that:
(explain)
AND
(If you checked Block 3 above check a. or b. below.)
I certify that I have made the following efforts, if any, to give notice to the defendant and give the following reasons
a.
supporting why notice should not be required:
(explain)
I certify that there is good cause to grant the remedy because the harm that the remedy is intended to prevent would likely
b.
occur if the respondent w as given any prior notice of the request for relief in that:
(Give specific reasons why harm would occur if
prior notice were given to defendant.)
4. An order directing the respondent :
a.
To not visit, assault, molest, or otherwise interfere with the employer or the employer's employee at the employer's
workplace, or otherwise interfere with the employer's operations .
b.
To cease stalking the employer's employee at the employer's workplace.
c.
To cease harassment of the employer or the employer's employee at the employer's workplace.
d.
To not abuse or injure the employer, including the employer's property, or the employer's employee at the employer's
workplace.
e.
To not contact by telephone, written communication, or electronic means the employer or the employer's employee at the
employer's workplace.
f . Other relief sought:
5.
To treat this verified Complaint as an Affidavit for all purposes requiring an Affidavit.
6.
Other:
(specify)
Date
Signature Of Person Filing Complaint
VERIFICATION
I, the undersigned, being first duly sworn, say that I hold the position of
(position with
in this action; that I have read the Complaint and Motion; that the matters and things alleged in the Complaint and Motion are
petitioner)
true except as to those things alleged upon information and belief and as to those I believe them to be true and accurate.
Date
SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME
Signature Of Person Signing Complaint
Date
Signature
Name Of Person Filing Complaint (Type Or Print)
Deputy CSC
Clerk Of Superior Court
District Court Judge
Assistant CSC
Designated Magistrate
Date My Commission Expires
Notary
County Where Notarized
SEAL
AOC-CV-530, Side Two, New 7/11
© 2011 Administrative Office of the Courts
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