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introduction to the eeo strategic plan - Ohio Bureau of Workers ...

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4. Is your condition permanent?<br />

5. Please list all <strong>of</strong> <strong>the</strong> activities that you can not perform because <strong>of</strong> your condition.<br />

6. Please state specifically <strong>the</strong> accommodation that you are proposing.<br />

I certify that all information is accurate <strong>to</strong> <strong>the</strong> best <strong>of</strong> my knowledge.<br />

Employee Signature<br />

Date<br />

Approved:<br />

Direc<strong>to</strong>r <strong>of</strong> EEO<br />

Date<br />

Disapproved:<br />

Direc<strong>to</strong>r <strong>of</strong> EEO<br />

Date<br />

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