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… include, but not limited to: Lifting, sleeping, concentrating, breathing, working, eating, walking,
standing, reaching, thinking, reading, bending, hearing, seeing, speaking, learning, sitting, and caring for self.
Yes
No
Does the disability affect your ability to perform the essential functions of the job?
Yes
No
Have you applied for FMLA for the same …
https://www.wichita.edu/services/humanresources/Total_Rewards/Leave/ADAAA/ADA_Accommodation_Employee_Request_Form.pdf