introduction to the eeo strategic plan - Ohio Bureau of Workers ...
introduction to the eeo strategic plan - Ohio Bureau of Workers ...
introduction to the eeo strategic plan - Ohio Bureau of Workers ...
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Release <strong>of</strong> health information<br />
I,<br />
Social Security #<br />
give permission <strong>to</strong> release medical information <strong>to</strong>:<br />
Date <strong>of</strong> Birth<br />
BWC<br />
EEO Department<br />
30 W. Spring Street, Level 28<br />
Columbus, <strong>Ohio</strong> 43215-2256<br />
This information will be used <strong>to</strong> verify a request for accommodation under <strong>the</strong><br />
American’s with Disabilities Act.<br />
Signature<br />
Date<br />
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