The name, address, email, and telephone number of the employer (or employment agency or union) you want to file your charge against. The declaration option does not require notarization; you need only fill in the blanks with the date and your location (city, state), and sign the declaration.A Charge of Discrimination can be completed through our EEOC Public Portal after you submit an online inquiry and we interview you. The EEO1 form submission deadline is approaching. Here's what employers need to know about the form, including how to fill it out. PURPOSE: The purpose of this form is to assist you in filing a discrimination complaint. A description of why you believe you were discriminated against, such as because of your race, ethnicity, sex, age, disability, pregnancy, or other reasons.