403.7E3 - Religious Accommodation Request Form - Currently Suspended

403.7E3 - Religious Accommodation Request Form - Currently Suspended

 

RELIGIOUS ACCOMMODATION REQUEST FORM

Date:

 

Employee Name:

 

Email Address:

 

Position/Job Title:

 

Employee Telephone Number:

 

Employment Location:

 

 

(1) Please identify the policy requirement or practice that conflicts with your sincerely held religious observance, practice or belief:

(2) Please describe the nature of your sincerely held religious beliefs or religious practice or observance that conflict with the policy or practice you have identified above:

(3) What are you requesting an accommodation from?

 

Item

Yes/No

Vaccination for COVID-19

 

Testing for COVID-19

 

Use of Face Coverings

 

 

 

 

___________________________________  ________________________________

Employee Signature Date
Office Use

This request has been:

______________________________  ________________________________

Approved Denied

_________________________________________  ______________________________

Administrator Date

 

 

This policy was suspended at the January 12, 2022 Board meeting.

nmckinnon@clar… Tue, 01/18/2022 - 12:00