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DHR EO O10 <br />(Re -issued: July 2018) <br />CONFIDENTIAL <br />County of Hawaii <br />Reasonable Accommodation Request Form <br />for Job Application Process, up to and Including Interview <br />Please complete this form and submit it to the staff person identified to <br />receive accommodation requests for the job application process. <br />Name: <br />Address or other contact information: <br />Position applied for: <br />Department: <br />Accommodation requested for: <br />(Please check all that apply) <br />❑ Application process <br />❑ Testing/examination <br />❑ Interview <br />❑ Accessibility to facility <br />Type of accommodation requested: <br />Telephone No. <br />Accommodation needed for (specify date, time, and location): <br />