Do you regard yourself as having a sincerely held religious belief, observance, or practice that you believe should exempt you from ’s COVID-19 Vaccination Policy? YES NO.Part 1 - To be completed by employee requesting accommodation If you have any questions about an accommodation or exemption request you made, please contact in the Human Resources Department. strives to make these determinations expeditiously and in a fair and nondiscriminatory manner and will inform you after we make a determination. makes determinations about requested accommodations and exemptions on a case-by-case basis, considering various factors and based on an individualized assessment in each situation. Refusing to provide the information requested in this form may impact ’s ability to adequately understand your request or effectively engage in the interactive process to identify possible accommodations. This information will be used by Human Resources or other appropriate personnel to engage in an interactive process to determine the precise limitations of your ability to comply with ’s COVID-19 Vaccination Policy and explore potential reasonable accommodations that could overcome those limitations. To request an accommodation related to ’s COVID-19 Vaccination Policy, please complete this form and return it to Human Resources. will provide reasonable accommodations for employees’ sincerely held religious beliefs, observances, and practices that conflict with getting vaccinated for COVID-19, as long as the requested accommodation does not create an undue hardship for or pose a direct threat to you or others in the workplace. As such, complies with all laws protecting employees’ religious beliefs and practices. Is committed to providing equal employment opportunities without regard to any protected status, and a work environment that is free of unlawful harassment, discrimination, and retaliation. I further understand that is not required to provide this exemption accommodation if doing so would pose a direct threat to myself or others in the workplace or would create an undue hardship for. I understand that any falsified information can lead to disciplinary action, up to and including termination. I verify that the information I am submitting to substantiate my request for exemption from 's vaccination policy is true and accurate to the best of my knowledge. Whether you have received vaccines as an adult against any other diseases.Whether your religious objection is to the use of all vaccines, a specific type of vaccine or some other subset of vaccines.How long you have held the religious belief underlying your objection.Please provide any additional information that you think may be helpful in reviewing your request. Please describe the nature of your sincerely held religious beliefs or religious practice or observance that conflicts with the vaccination requirement: I am requesting a religious exemption from 's mandatory vaccination policy for the following vaccination(s): To request an exemption from required vaccinations, please complete the form below and return this form to the human resources department.
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