Va Religious Exemption Form

Va Religious Exemption Form - Web form prior to submission to your supervisor. Rac will assign log number below for record keeping purposes. Web employees should provide this form to the rac. Fully vaccinated (required documentation attached): Web regarding disability requests, approvals will be annotated on both the va form 10230a and va form 0857f, accommodation request determination, in accordance with va handbook 5975.1. This form should be retained separately from the employee's official personnel folder. Received the seasonal influenza vaccine this flu season. Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d. Trainee, resident, intern, fee basis, or researcher) please indicate: Regarding religious requests, approvals will be annotated on va form 10230b and written notice of the approval

Fully vaccinated (required documentation attached): Please read the descriptions below to learn the criteria to request a medical or religious exception. Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d. This form should be retained separately from the employee's official personnel folder. Check one statement below and complete and sign the last section of this form prior to submission to employee occupational health: Number __________________________________ the administration of immunizing agents conflicts with the above named student's/my religious tenets or. Web regarding disability requests, approvals will be annotated on both the va form 10230a and va form 0857f, accommodation request determination, in accordance with va handbook 5975.1. Form cre 1 is an affidavit stating that the administration of immunizing agents conflicts with the student's religious tenets or practices. Web employees should provide this form to the rac. I have read and fully understand the information on this form and have been given the opportunity to have my questions answered.

Form cre 1 is an affidavit stating that the administration of immunizing agents conflicts with the student's religious tenets or practices. Web form prior to submission to your supervisor. Web regarding disability requests, approvals will be annotated on both the va form 10230a and va form 0857f, accommodation request determination, in accordance with va handbook 5975.1. Rac will assign log number below for record keeping purposes. Check one statement below and complete and sign the last section of this form prior to submission to employee occupational health: Fully vaccinated (required documentation attached): You may select medical exception, religious exception, or select both if you meet the criteria for both a medical and religious exception. Trainee, resident, intern, fee basis, or researcher) please indicate: This form should be retained separately from the employee's official personnel folder. Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d.

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I Have Read And Fully Understand The Information On This Form And Have Been Given The Opportunity To Have My Questions Answered.

Received the seasonal influenza vaccine this flu season. Fully vaccinated (required documentation attached): Rac will assign log number below for record keeping purposes. Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d.

Number __________________________________ The Administration Of Immunizing Agents Conflicts With The Above Named Student's/My Religious Tenets Or.

Regarding religious requests, approvals will be annotated on va form 10230b and written notice of the approval Web employees should provide this form to the rac. Web form prior to submission to your supervisor. Web regarding disability requests, approvals will be annotated on both the va form 10230a and va form 0857f, accommodation request determination, in accordance with va handbook 5975.1.

This Form Should Be Retained Separately From The Employee's Official Personnel Folder.

Trainee, resident, intern, fee basis, or researcher) please indicate: Check one statement below and complete and sign the last section of this form prior to submission to employee occupational health: Form cre 1 is an affidavit stating that the administration of immunizing agents conflicts with the student's religious tenets or practices. The student or his parent or guardian submits a notarized certificate of religious exemption (form cre 1), to the admitting official of the school to which the student is seeking admission.

You May Select Medical Exception, Religious Exception, Or Select Both If You Meet The Criteria For Both A Medical And Religious Exception.

Please read the descriptions below to learn the criteria to request a medical or religious exception.

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