Please complete the forms below to register with the EARC.
EARC Intake Form (PDF)* -to be completed by employee requesting employment accommodations.
EARC Verification Form (PDF)* -to be completed by appropriate professional.
*If you are using Google Chrome or Mozilla Firefox and are unable to view these documents, please switch to the Internet Explorer browser.
Registered Employee Forms
The following employment accommodation request form is to be used by employees who: (1) are currently registered with the EARC; (2) are requesting continued and/or additional employment accommodations for an exisiting condition(s) currently registered with the EARC; and (3) have previously prescribed employment accommodations by EARC for existing condition(s) currently registered with EARC.
Note: An employee registered with the EARC has provided the EARC with medical/psychological disability verification that qualifies him/her as an individual with a disability under FEHA and/or ADA, as amended.