DOLI – Virginia Department of Labor and Industry - Regulatory Advisory Panel Recommendation Form

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Who are you completing this recommendation for?

Recommending myself

Recommending someone else

Your Information

Name(Required)

First Last

Occupation or Role(Required)

Industry(Required)

Area of Expertise(Required)

Please describe your experience.(Required)

Please describe the community, industry, population, organization, or subject-matter expertise you represent.(Required)

Email(Required)

Phone(Required)

Person Being Recommended

Name(Required)

First Last

Occupation or Role(Required)

Industry(Required)

Area of Expertise(Required)

This person represents or has experience with:(Required)

Please describe the community, industry, population, organization, or subject-matter expertise they represent.(Required)

Email(Required)

Phone(Required)

Your Information (Recommender)

Name(Required)

First Last

Email(Required)

Phone(Required)

Relationship to the Person Being Recommended(Required)

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