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 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.
