Disability Questionnaire
We are a proud supporter of disabilities in the workplace. We encourage all staff members to disclose any special requirements so we can help to ensure safety and comfort in the workplace!
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Your first name *
Your last name *
Which of the following options describe your disability? Select ALL that apply. *
We want to create a work environment that is comfortable and accommodating. Would you like us to contact you to discuss any special requirements that you may have? *
Is there anything else we can do to help support you?
Additional information or comments:
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