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2. ALL EMPLOYEES ARE REQUIRED TO ACKNOWLEDGE RECEIPT OF AND ACCEPTANCE OF THE PREGNANT WORKERS FAIRNESS ACT.
4. YOUR INFORMATION
6. First Name:
7. Last Name:
8. Position/Title/Role:
10. Email Address:
11. Primary Phone Number:
13. Department/Board/Committee Name:
17. ACKNOWLEDGEMENT OF RECEIPT OF THE PREGNANT WORKERS FAIRNESS ACT
19. Enter Your Full Name:
    By typing your full name above you are acknowledging that you have received and read the Pregnant Workers Fairness Act Policy.
20. Date of Receipt:
    Date of Receipt:
24. SUBMIT YOUR ACKNOWLEDGEMENT AND RECEIPT
28. Leave the box below checked and enter your desired email address to receive a copy of your form submission:
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30. 1. Receive an email copy of this form.
31. Email address

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32. Submit

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