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Medical Accommodation Form

As part of the interactive process when someone submits a request for a medical accommodation, we require a note from your medical provider that supports the request. Typically, your medical provider should state in the note that you are under their care and provide us with their instructions about your accommodation request as well as the anticipated duration that the accommodation request is expected to be required. You do not need to include information regarding your specific diagnosis. Please upload that to this page. Incomplete medical accommodation requests will not be considered.


I certify and agree that:

The information I am submitting in support of my request for an accommodation is true and accurate. I understand that any intentional misrepresentation contained in this request may result in disciplinary action up to and including termination of employment or the withdrawal of a conditional offer of employment. I also understand that an accommodation may not be granted if it is not reasonable, if it poses a direct threat to the health and/or safety of others in the workplace and/or to me, or if it creates an undue hardship on the Company.

Religious Accommodation Form