Americans With Disabilities Act (ADA) Request For Reasonable Accommodation

americans with disabilities act (ada) request for reasonable accommodation individuals with a aqualified@ disability are protected agains

Americans with Disabilities Act (ADA)
Request for Reasonable Accommodation
Individuals with a Aqualified@ disability are protected against
discrimination by the Americans with Disabilities Act (ADA) and the
Fair Employment and Housing Act (FEHA). To be considered as having a
qualified disability you must be significantly restricted in the
ability to perform either a class of jobs or a broad range of jobs.
To be eligible for an accommodation you must have a Aqualified@
disability. An individual is considered to have a disability if that
person has:
1.
A physical impairment, mental impairment, or medical condition
that limits one or more major life activities (e.g., walking,
speaking, breathing, performing manual tasks, seeing, hearing,
learning, caring for oneself, sitting, standing, lifting, reading,
and working).
2.
A record of such impairment (e.g., a history of having had an
impairment caused by cancer though you currently do not have the
impairment and may be free of cancer).
3.
Is regarded as having such impairment.
The ADA and FEHA does not require employers to hire or promote
unqualified or lesser qualified individuals. All individuals must be
able to perform the essential functions of the job and meet the
educational and experience prerequisites for that position. Employers
are free to determine the standards of proficiency or productivity
associated with performing the essential functions of the job and to
select the most qualified individuals.
Identifying a reasonable accommodation is a cooperative process that
will be evaluated individually. Inquiries regarding accommodations can
be made to the ADA Coordinator or by completing a Reasonable
Accommodation form.
ADA Coordinator
Los Angeles County Sheriff's Department
Bureau of Labor Relations and Compliance
211 W. Temple Street, 5th Floor
Los Angeles, CA 90012
E-mail:[email protected]
Phone: (213) 229-1621
TTY: (213) 626-0251
After hours phone: (866) 234-3438
Please complete and forward one copy for evaluation to:
ADA Coordinator, Bureau of Labor Relations and Compliance, 4700 Ramona
Blvd., Rm 234, Monterey Park CA, 91754, Phone (323) 526-5671,
E-mail:bocadacomp.lasd.org
Rec=d by__________________________________________________
Phone__________________________ Date_________________________
Examination Title __________________________________________________
(If Applicable)
Accommodation Recommended __ Yes __ No Authorized
by__________________________________________ Date ______________
SH-AD 679 (8/15)
Los Angeles County Sheriff’s Department
Americans with Disabilities Act (ADA)
Request for Reasonable Accommodation
Last Name First Name MI
Home Address City State Zip
Phone TTY: Email Address:
Describe the impairment and how it limits one or more major life
activities. (Additional sheet if necessary)
Describe the type of accommodation requested. (Additional sheet if
necessary)
All requests for accommodations will be evaluated individually. You
may be asked to provide the name, address, and phone number of a
qualified professional who can verify your impairment and the need for
the accommodation.
Signature: Date:
SH-AD 679 (8/15)