Accommodation Request - Kaiser Permanente Careers

Date of Request:

Is this accommodation for yourself or for someone else?

Are you a current Kaiser Permanente employee?

Yes
No

Enter NUID:

Last Name:

First Name:

Email:

Phone Number:

Is this request for:

Current Position
New Position

Which City and State is the accommodation needed?

State:

City:

Please provide the specifics of the jobs(s) for which the seeker is submitting:

Job Number(s):

Department(s):

Job Title(s):

What type of accommodation are you requesting?

The information you provide will be maintained in a confidential manner. It will only be disclosed on a strict business need to know basis for the purpose of assessing and providing the requested disability accommodation. KP may require medical documentation and other information to fully evaluate your need for accommodations. If you fail to provide required medical information, KP may not be able or obligated to provide an accommodation.