Va Religious Exemption Form. This form should be retained separately from the employee's official personnel folder. Received the seasonal influenza vaccine this flu season.
Vaccine Exemption Form Formstack
Regarding religious requests, approvals will be annotated on va form 10230b and written notice of the approval Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d. Trainee, resident, intern, fee basis, or researcher) please indicate: Web form prior to submission to your supervisor. Fully vaccinated (required documentation attached): Form cre 1 is an affidavit stating that the administration of immunizing agents conflicts with the student's religious tenets or practices. I have read and fully understand the information on this form and have been given the opportunity to have my questions answered. 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. Check one statement below and complete and sign the last section of this form prior to submission to employee occupational health:
This form should be retained separately from the employee's official personnel folder. 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. Check one statement below and complete and sign the last section of this form prior to submission to employee occupational health: This form should be retained separately from the employee's official personnel folder. 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. Regarding religious requests, approvals will be annotated on va form 10230b and written notice of the approval Form cre 1 is an affidavit stating that the administration of immunizing agents conflicts with the student's religious tenets or practices. Fully vaccinated (required documentation attached): Web commonwealth of virginia certificate of religious exemption name ____________________________________ birth date _______________________ student i.d. You may select medical exception, religious exception, or select both if you meet the criteria for both a medical and religious exception.
