RESEA - EEO Customer Acknowledgment Form

Re-Employment Services and Eligibility Assessment (RESEA) Program

Customer Acknowledgment of Equal Employment Opportunity (EEO) Form

Today's Date EEO initial entry date

One-Stop Office (As indicated on the RESEA selection notice) Value is not selected

First Name

Last Name

Last 4 digits of Social Security #: Must be numeric

Email Address:

Your Phone Number:

PARTICIPANT CERTIFICATION

1. Click here to download the EEO publication (signature not required; view EEO contact information via link below)

2. Click here to view the Equal Opportunity Officers list.

CERTIFICATION STATEMENT: I have read the EEO publication.

I agree with the certification statement, and I will e-sign. *

Yes, I received the publication: *

Know Your Rights: Equal Opportunity Is the Law, which...

• Explains the equal opportunity law,
• Informs me of my right to file a complaint, and
• Describes the types of complaints and filing requirements.

One-Stop Career Center staff explained these rights to me, gave me the opportunity to ask questions, and included the name, address and telephone number for the One-Stop Career Center Complaint Specialist, the Workforce Development Board (WDB) Equal Opportunity Officer, and the State Equal Opportunity Office.

Customer Name:

Date:

One Stop Location Email Group LO

County Team Member Email

County Team Member Name

EEO Participant Name

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RESEA - EEO Customer Acknowledgment Form

PARTICIPANT CERTIFICATION