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EEOC Charge Form

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EEOC CHARGE OF DISCRIMINATION FORM

Charging Party Information

Full Name:

Date of Birth:

Position and Employment Information

Date Hired:    Date Separated (if applicable):

Employer / Respondent Information

Employer Phone:    Contact Person / Supervisor:

Employment History (Most Recent Two Employers)

Title:    Dates Employed: From to

Title:    Dates Employed: From to

Education

Graduation Date:

References / Witnesses

Reference 1 — Name:    Phone:

Reference 2 — Name:    Phone:

Reference 3 — Name:    Phone:

Allegation Details

Date discrimination began:    Date of last occurrence:

Other (describe):

Other Action (describe):

Representative Information (if any)

Are you represented by an attorney or other representative?

Prior Complaints / Administrative Filings

Have you filed a complaint about this matter with any other federal, state, or local agency?

Authorization, Certification, and Notices

Authorization: I authorize the agency to investigate the allegations made in this charge and to obtain relevant employment, medical, and personnel records from my current and former employers, educational institutions, and other third parties as necessary to the investigation. I further authorize the release of such records. I also authorize the agency to provide copies of this charge and related information to the employer, witnesses, and other relevant parties when necessary to the investigation or conciliation of the charge.

Certification: I certify that the information provided in this charge is true and complete to the best of my knowledge. I understand that knowingly making a false statement in this charge may subject me to penalties under applicable law.

Equal Opportunity Statement: This charge is submitted for the purpose of initiating an administrative investigation into the matters alleged. Submitting this charge does not guarantee any particular outcome or remedy.

Applicant Certification and Signature

I certify under penalty of perjury that the foregoing is true and correct to the best of my knowledge. I understand that submission of this charge authorizes the agency to proceed with an investigation and to disclose information as necessary to effectuate that investigation.

Name (Print):

Signature:

Date:

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What the EEOC Charge Form Is and when to use it

The EEOC Charge Form is the formal document an individual uses to report alleged workplace discrimination to the U.S. Equal Employment Opportunity Commission (EEOC) or an authorized state fair employment practices agency. Filing a charge starts the EEOC intake and investigative process and preserves the filer’s right to administrative remedies and, in most cases, a federal lawsuit after exhaustion of agency procedures. The form captures complainant details, employer information, dates and descriptions of discriminatory acts, and the bases alleged (for example race, sex, disability, age). Electronic filing and eSignature are accepted and commonly used by filers and counsel.

Why completing an accurate EEOC Charge Form matters

A properly prepared charge preserves statutory rights, triggers agency investigation, and creates a formal record for mediation or litigation. Accuracy and timeliness affect whether the EEOC or state agency can accept and investigate the claim.

Why completing an accurate EEOC Charge Form matters

Who typically files or completes an EEOC Charge Form

The EEOC Charge Form is used by individuals, their representatives, and occasionally by employers during internal resolution processes.

  • Employees or applicants alleging discrimination who want to preserve administrative remedies and obtain an agency investigation.
  • Attorneys or authorized representatives submitting a charge on behalf of an individual or group.
  • Human resources or compliance officers preparing a defensive or explanatory statement in response to a charge.

The filing party should provide accurate contact and incident details; representatives must include authorization or power-of-attorney information when applicable.

Step-by-step: completing and filing an EEOC Charge Form

Follow these sequential steps to prepare a clear and timely charge.

  • 01
    Gather documents: Collect offer letters, termination notices, policies, and relevant emails.
  • 02
    Complete form: Enter required fields, describe incidents clearly and chronologically.
  • 03
    Sign and date: Sign the form (electronic or handwritten) and confirm contact details.
  • 04
    Submit to agency: File with EEOC or the appropriate state agency via online portal or mail.

How filing an EEOC Charge initiates agency review

A charge creates an administrative case that moves through intake, possible mediation, investigation, and a closure or right-to-sue phase.

  • Intake: Agency confirms jurisdiction and timeliness of the allegation.
  • Mediation: Parties may be offered confidential mediation to resolve the dispute.
  • Investigation: EEOC or state agency gathers evidence and interviews witnesses.
  • Outcome: Agency issues findings, dismissal, or issues a Notice of Right to Sue.

Setting up an electronic filing workflow for the charge form

Configure a structured routing workflow to collect signatures, attachments, and retain an audit trail.

Field Configuration
Document Upload Accept PDF and DOCX attachments up to typical agency limits
Signer Authentication Use email link or SMS code for signer attribution
Conditional Fields Reveal additional fields when multiple bases are selected
Retention Settings Enable audit trail and download signed copy automatically

Technical considerations for eFiling and eSigning

Confirm platform capabilities for admissibility, secure transmission, and records retention before eFiling or eSigning an EEOC charge.

  • Supported formats: PDF and DOCX supported
  • Integrations: Works with common storage platforms
  • Authentication: Email, SMS, or stronger options

Ensure the chosen provider preserves an audit trail (timestamps, IP addresses), offers encryption in transit and at rest, and can produce a reproducible record suitable for agency review and legal purposes.

Key security and compliance checkpoints

Encryption: TLS 1.2/1.3; AES-256 at rest
Audit Trail: Tamper-evident timestamped logs
ESIGN / UETA: Legal framework compliance
HIPAA (BAA): BAA required for PHI handling
SOC 2 Type II: Independent security attestation
21 CFR Part 11: Support for regulated records

Consequences of incomplete or late charges

Missed deadline: Charge barred
Insufficient detail: Investigation limited
Incorrect respondent: Misrouted or dismissed
False statements: Potential legal exposure
Lost evidence: Weakened case
Privacy breaches: Regulatory liability

Common preparation mistakes to avoid

  • Providing vague incident descriptions that lack dates, locations, or actor identification can prevent investigators from establishing a coherent timeline and may limit the scope of inquiry.
  • Using an employer’s informal or abbreviated legal name instead of the registered legal entity can cause misidentification and delay intake or result in a misfiled charge.
  • Failing to attach or reference supporting documents such as termination notices, performance reviews, or emails reduces the ability of the agency to corroborate allegations during the initial assessment.
  • Omitting accurate contact information or failing to update an address or phone number can lead to missed agency correspondence and procedural dismissal for lack of prosecution.

Key timing rules and filing windows

Timeliness is essential; file within the applicable statutory window to preserve administrative remedies and potential civil litigation rights.

Federal EEOC deadline:

File within 180 days of alleged act in most jurisdictions

State filing extension:

Up to 300 days where a state agency enforces also

Multiple incidents:

Timeliness measured from most recent discriminatory act

Amendments:

You may amend a charge to add facts or bases during intake

Right-to-sue notice:

Issued after investigation or dismissal; preserves litigation option

Milestones after filing an EEOC Charge

After filing, expect a sequence of agency actions that culminates in a closure letter or a right-to-sue notice.

01

Filing Acknowledgment

Agency records receipt and assigns a charge number

02

Initial Assessment

Agency reviews jurisdiction and screening facts

03

Investigation or Mediation

Evidence gathered or mediation offered to the parties

04

Closure / Right-to-Sue

Final determination or notice permitting court action

Illustrative scenarios using the EEOC Charge Form

Two brief examples show how typical filings look and what they achieve.

Individual Filing

A retail associate alleges repeated gender-based remarks by a supervisor and documents dates and witnesses.

  • EEOC offers mediation within 60 days.
  • Mediation resolves the dispute confidentially, and the agency closes the investigation with a settlement agreement between parties.

Attorney-Assisted Charge

An attorney files on behalf of a client after termination for disability-related reasons and attaches medical and performance records.

  • EEOC opens a full investigation.
  • The investigation yields cause findings and leads to a negotiated resolution or issuance of a Notice of Right to Sue.

Essential components of a professional EEOC Charge Form

A complete charge form contains standardized sections and supporting material to help the agency evaluate jurisdiction and the merits of the allegation.

Complainant information

Full legal name, contact details, and representative information if applicable.

Respondent identification

Employer legal name, address, and known decision-makers or HR contacts.

Allegation summary

Clear, chronological description of the conduct and adverse actions alleged.

Protected bases

Specific categories claimed, such as race, sex, age, religion, or disability.

Dates and timeline

Exact or approximate incident dates and duration of discriminatory pattern.

Attachments

Supporting evidence such as emails, policies, performance documents, or medical records.

Practical tips for a clear, agency-ready charge

Adopt these best practices to improve completeness, reduce delays, and strengthen investigatory review.

Be chronological and specific
List events in order with dates, locations, and individuals involved to help investigators quickly assess facts.
Attach key documents
Include termination letters, emails, policies, and witness names where available to support your allegations.
Use precise legal bases
Select specific protected categories rather than general terms to ensure the charge is routed correctly.
Keep copies and records
Retain signed copies, emails, and submission confirmations for your records and potential litigation.

Typical signatories and their roles

Complainant — Individual

An employee or applicant signs to verify the charge contents and consent to agency processing; their signature confirms intent and attribution for ESIGN/UETA purposes and supports subsequent investigation steps.

Representative — Attorney

An authorized attorney or representative signs to file on behalf of a complainant; authorization should be documented and included to avoid questions about standing or representation.

Frequently asked questions about the EEOC Charge Form

Answers to common procedural and technical questions when preparing or submitting a charge.


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