Please complete the forms below to register with the EARC. Be sure to refer to the EARC Prospective Employee Registration Checklist (PDF) for a detailed guide to the EARC employee registration and employment accommodation request process.
EARC Intake Form (PDF)* -to be completed by employee requesting employment accommodations.
EARC Medical/Psychological Disability Verification Form (PDF)* -to be completed by appropriate professional.
*If you are using Google Chrome and are unable to view these documents, please switch to a different browser, download the PDF and open it using Adobe products, or disable the Chrome PDF viewer.
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.
EARC Employment Accommodations Request Form (PDF) - to be completed by the employee requesting employment accommodations.