Request to Return to Work: COVID-19 Related

Return To Work Request

Lordco Auto Parts is dedicated to providing its team members with a safe and healthy work environment. You have been absent from the workplace for reasons related to the outbreak of COVID-19. In order to protect our employees and the safety of our workplace, Lordco must do its due diligence before allowing you to return back into our shared work environment. In order to process your request, please complete and submit this form.

Part 1

Were you absent due to any of the following reasons:

If you answered No to all of Part 1, please complete Part 2. If you answered Yes to any of the questions in Part 1, you may submit the form now.

Part 2

Were you absent due to any of the following reasons: