Seattle Health Care workers Hotel Room

This is an application for accommodations in Seattle. Please review the eligibility requirements. If you don’t know the answers to a question or aren’t sure if you’re eligible, fill it out to the best of your ability and someone from UFCW 21 will contact you to help figure out your situation and book your room.

The form to apply for a room in Bellevue is here: https://form.jotform.com/201034099803147

Name*

First NameLast Name

Work Location*

Job Title*

Phone Number*

Area CodePhone Number

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Anticipated length of stay BEGINNING:

Anticipated length of stay ENDING:

Time of arrival (The hotel would like a 2 hour notice)

Food allergies or restrictions

Parking needs

Confirm Eligibility

I am a health care worker, and I am healthy but cannot stay at home to avoid further exposure to a confirmed COVID-19-positive household member, or I need to avoid long commutes between lengthy shifts.I am a health care worker, and I am currently healthy but have a vulnerable member of my household and need to protect them from potential exposureI am a health care worker who has been exposed to COVID-19 and cannot self-quarantine at homeI am a health care worker who has tested positive for COVID-19 and have minor or no symptoms (symptoms that do not require hospitalization), and cannot self-quarantine at home