Form 557-3 - Human Resource Officer Decision Form - Texas Military Department printable pdf download

Form 557-3 - Human Resource Officer Decision Form - Texas Military Department

Texas Military Department

Equal Opportunity/Equal Employment Office

HUMAN RESOURCE OFFICER DECISION FORM

Date: _______________

Accommodation Request is:

____ Approved

____ Denied

____ Modified

If APPROVED, indicate what accommodation will be provided. If MODIFIED, describe modification

and provide reason. If DENIED, complete item 4 below.

APPROVED ACCOMMODATION: ______________________________________________________________________

REQUEST MODIFIED: _______________________________________________________________________________

______________________________________________________________________________________________________

REQUEST DENIED: check reasons for denying the accommodation. (Check all that apply)

____ The individual did not provide documentation of a disability that substantially limits a major life activity.

____ The requested accommodation is ineffective (will not enable individual to perform the essential functions of

the position).

____ The individual’s disability/limitations do not prevent him/her from performing the essential functions of the

position.

____ The accommodation/modification request will:

____create an undue administrative burden

____create an undue impact on operations

____fundamentally alter the nature or operation of the facility

____require lowering of current performance standard(s)

____ An effective accommodation that would not pose an undue hardship was offered, but was rejected by the

individual.

______________________________________

___________________________________

HRO Approval Authority (Print)

State Equal Employment Manager (Print)

_______________________________________

___________________________________

Signature/Date

TMD Form 557-3

1 March 2017

Form 557-3 - Human Resource Officer Decision Form - Texas Military Department