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Confidential Request for Medical Information - Job Applicant - DHR EO Ol 4B <br />Page 3 of 4 <br />Under the Americans with Disabilities Act, an individual with a disability is entitled <br />to an accommodation in the job application process only when the <br />accommodation is needed because of a disability. <br />is applying for the position of <br />(Name of the individual) <br />The application process involves (check all that apply) <br />o completing an application <br />o taking a test to determine knowledge <br />o taking a skills test <br />o participating in a job interview. <br />What limitation(s) would interfere with any of the activities noted above? <br />Reasonable accommodations are modifications or adjustments to the job <br />application process that would enable an individual with a disability to apply for <br />the position. <br />If the individual has a disability and needs an accommodation to apply for a job <br />because of the disability, the employer must provide a reasonable <br />accommodation, unless the accommodation poses an undue hardship. <br />Do you have any suggestions regarding possible accommodations to assist <br />—..................................... .........._..._.........._ in the job application process? <br />(name of individual) <br />If yes, what are they? <br />How would your suggestions assist <br />(name) <br />in applying for a job? <br />