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.Complete this form to make a report of discrimination. You can make this report whether or not you wish to be involved in an official complaint. A Charge of Discrimination can be completed through our EEOC Public Portal after you submit an online inquiry and we interview you. Provide the information below for each plaintiff named in the complaint. Attach additional pages if needed. Name. View the various Human Resources documents, forms, and disclosures at Clark University. Complaint for Employment Discrimination. Download. Law 93-579, authority to request personal data and its uses are: 1.