EEOC Form 5 (11/09) - Experienced Florida Lawyers
COLOR. SEX. RELIGION. NATIONAL ORIGIN. RETALIATION. AGE. DISABILITY. GENETIC INFORMATION. OTHER (Specify) Pregnancy. CONTINUING ACTION. THE PARTICULARS ARE (If additional paper is needed, attach extra sheet(s)): \ I want this charge filed with both the EEOC and the State or local Agency, if any. ................
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