Sample Application Form--Request for Reasonable Accommodation

This application is only a sample application that may be used to request a reasonable accommodation. If an employee would like to submit a request, he/she must contact his/her supervisor or the agency's designated responsible person for reasonable accommodation.

To view and print this form you need Adobe Acrobat Reader™ (which is free) from Adobe Systems. If you do not have Adobe Acrobat Reader™ and want to download it now click on the link to the Adobe web site below and follow their download instructions. Since Adobe Acrobat Reader™ comes in versions that run in DOS, Windows, Mac, UNIX and OS/2, be sure you download the correct version.

Link to Adobe Systems to download Adobe Acrobat Reader™

If you are still unable to access this form, a copy can be obtained by either writing to the New York State Department of Civil Service, Public Information Office, Building #1, The State Campus, Albany, New York 12239 or telephoning us at 518-457-9375.

DISCLAIMER: The Department of Civil Service is not responsible for Adobe Acrobat Reader™ or your use of it. The link above is provided for your convenience and does not in any way constitute an endorsement of this software product or company.

To Next Section
To Table of Contents