Based upon your sincerely held religious belief, we ask that you complete the below
attestation.
I truthfully acknowledge and affirm that my sincerely held religious belief is consistent and valid. I understand that any intentional misrepresentation contained in this request is subject to disciplinary action. I further understand that my employer is not required to provide this exemption if doing so would pose a direct threat to myself or others in the workplace. At any time if my exemption and/or associated accommodation, if any, creates an undue burden on
my employer, I understand I may not be able to continue to be actively employed if I do not receive a COVID-19 vaccination.
I affirm that I will also abide by the vaccine accommodation requirements as listed below and understand any failure to abide by accommodation requirements listed below may result in disciplinary action up to and including termination from employment:
• Approved religious exemption with signed attestation.
• Complete routine testing if requested by the exempted partner
• When community transmission does not require face masks to be worn, masks will still be provided if exempted partner chooses to wear.
• May subject to reassignment.
• Any state or CMS requirements or obligations that may apply.