Leave Form REVISED September 2015

An equal opportunity/affirmative action employer and agency.

Auxiliary aids and services are available upon request to individuals with disabilities.

TTY WV Relay 7-1-1

The R1WDB does not discriminate on the grounds of race, color, national origin, sex, sexual orientation, gender identity and/or expression, age, disability, political beliefs or religion be excluded from participation in, or denied, any aid, care, services, or other benefits provided by federal and/or state funding, or otherwise be subjected to discrimination.