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COVID-19 Rent Relief
Rent and Utilities Help for Tenants and Landlords
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Ayuda con la renta o los servicios públicos
Verifique elegibilidad y aplique
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Contra Costa County Says NO MORE
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Accommodation Request Online Form for Employees
This form has been modified since it was saved. Please review all fields before submitting.
What specific accommodation(s) are you requesting?
If you are not sure what accommodation(s) is needed, do you have any suggestions about what options we can explore? If yes, explain.
Is your accommodation request time sensitive? If yes, explain.
What, if any, essential job functions are you having difficulty performing?
Employment facilities and program
What, if any, employment facilities and program are you having difficulty accessing?
Limitation of access to facility or program
Contra Costa County Accommodation
Have you previously been accommodated during your employment with Contra Costa County? If yes, what were they and how effective were they?
You may be required to provide medical documentation, if necessary, to process your accommodation request, If you are unable to provide the necessary documentation, the County may obtain it's own medical assessment.
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