Fillable Ada Reasonable Accommodation Request Form REQUEST FOR REASONABLE ACCOMMODATION

Fill Online, Printable, Fillable, Blank Ada Reasonable Accommodation Request Form REQUEST FOR REASONABLE ACCOMMODATION Form

Use Fill to complete blank online CITY (AR) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Ada Reasonable Accommodation Request Form REQUEST FOR REASONABLE ACCOMMODATION

On average this form takes 3 minutes to complete

The Ada Reasonable Accommodation Request Form REQUEST FOR REASONABLE ACCOMMODATION form is 1 page long and contains:

  • 0 signatures
  • 2 check-boxes
  • 11 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City

BROWSE CITY (AR) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Revised 02-02-18
EMPLOYEE’S
REQUEST FOR REASONABLE ACCOMMODATION
In accordance with the Americans with Disabilities Act (ADA), I am requesting that the
City of Little Rock (hereafter the “City”) make reasonable accommodation to enable me
to perform the essential functions of the ________________________________ position.
(Please check one) I currently hold the above stated position.
I am a candidate for the above stated position.
Name: ____________________________________ Employee Number: ____________
(Please Print)
Address: _______________________________________________________________
Home Phone: ______________________ Work Phone: ________________________
NOTE: The information provided in the spaces below will enhance, and hopefully
expedite, the process of identifying and implementing a reasonable accommodation.
Therefore, it would be most beneficial for you to be as thorough as possible. Please
attach additional sheets if necessary.
Please describe the nature of your impairment (attach supporting medical documents):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please describe precise job related limitation(s) imposed by the condition (specific to the
position in question):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please suggest, as precisely as possible, the accommodation which you believe would
best serve the needs of you and the City: _______________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
______________________________ ____________________________________
Signature of Requestor Date
______________________________ ___________________________________
Labor & Employee Relations Designee Date Received
cc: Human Resources - Labor and Employee Relations Division
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Ada Reasonable Accommodation Request Form REQUEST FOR REASONABLE ACCOMMODATION

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 20 March 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document