The Americans with Disabilities Act requires an employer to provide an employee with a disability a reasonable accommodation to help the employee perform essential job functions. This form will help an employer obtain information from the employee concerning the accommodation request.
Updated to include amendments to the state medical marijuana law and the law regarding service animals in public accommodations, effective July 31, 2017.
As mandated by the California Civil Rights Department, an employer requiring an employee to submit written medical certification to support a request for a pregnancy-related reasonable accommodation, transfer or disability leave must provide the Certification of Health Care Provider.