Accommodation Request

If you have a disability and need an accommodation to complete the online application process, please complete your Accommodation Request below and a representative will be in contact to assist you:

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 accommodation. KP may request written documentation from the employee’s/job seeker’s health care provider. The employee/job seeker is responsible for providing KP with medical documentation that assists KP in assessing the employee/job seeker’s functional limitations to determine possible reasonable accommodations. If an employee/job seeker fails to provide necessary medical information, KP may not be obligated to provide an accommodation.