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. The name, address, email, and telephone number of the employer (or employment agency or union) you want to file your charge against.A Charge of Discrimination can be completed through our EEOC Public Portal after you submit an online inquiry and we interview you. 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. By completing this form, you are filing a complaint of employment discrimination asserting that the employer discriminated against you. An employee may file a charge if they believe an employer discriminated against them because of their citizenship, immigration status, or national origin. PURPOSE: The purpose of this form is to assist you in filing a discrimination complaint. Wake County, NC ; JOB TYPE. The Youth Employment Certificate will not be issued without the above steps being completed.