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Get DHS 3090-1 2011

Cribed in Item 15. RACE (Specify) AGE (Date of Birth) PHYSICAL OR MENTAL DISABILITY (Describe) COLOR (Specify) RELIGION (Specify) RETALIATION/REPRISAL (Dates of Prior EEO Activity) NATIONAL ORIGIN (Specify) GENETIC INFORMATION SEX (Specify) SEXUAL ORIENTATION pregnancy PARENTAL STATUS 17. WHAT REMEDIAL OR CORRECTIVE ACTION ARE YOU SEEKING TO RESOLVE THIS MATTER 18. ON THIS SAME MATTER, HAVE YOU FILED A GRIEVANCE OR APPEAL UNDER: Negotiated grievance procedure Agency grievance procedur.

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