Formulario De Autorizacion De Cuestionario En Linea - Oregon Bureau Of Labor And Industries

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DIVISIÓN DE DERECHOS CIVILES
FORMULARIO DE AUTORIZACIÓN DE CUESTIONARIO EN LÍNEA
Por favor firme y regrese a:
Oregon Bureau of Labor and Industries
Civil Rights Division
800 NE Oregon Street, Suite 1045
Portland, Oregon 97232
Nombre: (escriba en letras de molde)
Correo electrónico (como se indica en el
cuestionario)
Fecha de presentación de la solicitud en línea
Fecha de hoy
Certifico que la información que he dado en el cuestionario en línea de la División de Derechos Civiles es
completa y correcta a lo mejor de mi conocimiento. Estoy de acuerdo en permitir que la División de
Derechos Civiles se comunique conmigo y reconozco que el no responder a los intentos de la División de
Derechos Civiles de contactarme puede resultar en el cierre de mi petición.
Entiendo que el cuestionario en línea no es una queja formal presentada ante la División de Derechos
Civiles.
X
Your Signature

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