Farmers Business Network ®, and its subsidiaries and affiliates ("FBN®") are committed to complying with the Americans with Disabilities Act of 1990 (ADA) to provide reasonable accommodations for qualified applicants and employees with disabilities, unless such accommodations cause undue hardship. It is the policy of FBN®, at all levels to employ, to advance employment, and to treat qualified applicants and employees without discrimination. Where an applicant or employee is determined to have an ADA-qualifying disability, reasonable accommodation will be made.

To be eligible for reasonable accommodation, under the ADA, you must be qualified to perform the essential functions of your position.

By completing this form, I authorize the release of information regarding my disability to Farmer’s Business Network® and its subsidiaries and affiliates’ management (“FBN®”) as deemed necessary to facilitate this request for accommodation.