Va Form Exemption Fill Out and Sign Printable PDF Template signNow
Va Religious Exemption Form. Web form prior to submission to your supervisor. Web employees should provide this form to the rac.
Va Form Exemption Fill Out and Sign Printable PDF Template signNow
Trainee, resident, intern, fee basis, or researcher) please indicate: I have read and fully understand the information on this form and have been given the opportunity to have my questions answered. Web form prior to submission to your supervisor. 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. Please read the descriptions below to learn the criteria to request a medical or religious exception. 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. Number __________________________________ the administration of immunizing agents conflicts with the above named student's/my religious tenets or. 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.
Number __________________________________ the administration of immunizing agents conflicts with the above named student's/my religious tenets or. Trainee, resident, intern, fee basis, or researcher) please indicate: Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d. Regarding religious requests, approvals will be annotated on va form 10230b and written notice of the approval Number __________________________________ the administration of immunizing agents conflicts with the above named student's/my religious tenets or. 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: 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. Rac will assign log number below for record keeping purposes.
