Accommodation Request Statement With Multiple Conditions

State:
Multi-State
Control #:
US-216EM
Format:
Word; 
Rich Text
Instant download

Description

This form may be used to assist a company in determining to what extent a reasonable accommodation is required.
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FAQ

I would like to request accommodations so that I might be able to perform my job effectively before my performance starts to suffer. Workplace distractions interfere with my concentration and focus so I would like to try noise cancelling headphones to minimize sound distractions.

RA Statement Example: [Employer] is committed to providing access and reasonable accommodation in its services, activities, programs, and employment opportunities in ance with the Americans with Disabilities Act and other applicable laws.

In your reasonable accommodation letter, you should provide all the information your employer will need to begin the accommodation process, including what your disability is, how it affects you, which aspects of your job might require modification, and proposed accommodations.

As part of this commitment, [Employer] will ensure that persons with disabilities are provided reasonable accommodations for the hiring process. If reasonable accommodation is needed, please contact [include name and/or department, telephone, and e-mail address, etc.].

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Accommodation Request Statement With Multiple Conditions