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 Verification Form (PDF)* -to be completed by appropriate professional.
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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.