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. Employers are liable for errors in the completion of this form.ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. The Division of Human Rights complaint form is available at the below link. You may use this form to file and submit your complaint online. The average value of an employment discrimination case varies widely. Title VII of the Civil Rights Act of 1964 is a federal law that makes it illegal to discriminate employees based on race, color, religion, or sex. The name, address, email, and telephone number of the employer (or employment agency or union) you want to file your charge against. Please note we will need all of the above forms to be filled out along with applicable identification before we can begin to process your first pay. 4 One complete form appears in the record, but the form does not pertain to the 2019 job interviews. (Doc. 1714).