Religious Accommodation Form

Request for Religious Accommodation Form:

The following document is a record of request for a religious accommodation in the workplace in accordance with Title VII of the Civil Rights Act, 29 CFR 1605.2, and applicable state, federal, and local laws.

Employee Name

Job Title

Department

Date required

Employee I.D. or Social Security

Current Shift

Accommodation Request:

Description of the religious accommodation that is being requested, e.g., schedule change, deviation from dress code, time for daily prayer:

Description

Explanation of the religious nature of the practice and the way in which it conflicts with a work requirement. (Explanation does not need to name any specific religious denomination but rather describe the practice that the employee would like accommodated, such as prayer time at certain times of the day or being available to attend services on Sunday):

Explanation

Accommodation Response:

Accommodation is

Select One Required

Accepted

Denied

Partially Approved

Alternative Accommodation Proposed

Reason for Denial After Consultign with Legal Counsel:

Alternative Accommodation:

Alternative Proposed Accommodation Accepted by Employee

Select One Required

Yes

Requesting Employee's Signature

Today's Date: required

Supervisor's Signature

Today's Date: required

This company is an Equal Employment Opportunity employer and does not engage in practices that discriminate nor tolerate harassment against any person employed or seeking employment based on religion. Please notify a supervisor or Human Resources manager immediately if you feel that you have been subjected to such behavior.

Request for Religious Accommodation Form Instructions

Title VII of the federal Civil Rights Act of 1964 and state laws in most states prohibit employment discrimination based on religion. This includes refusing to accommodate an employee's sincerely held religious beliefs or practices unless the accommodation would impose an undue hardship on the business. The Request for Religious Accommodation Form can be completed by employees and submitted when a religious accommodation is sought or needed.

Why its Important

A religious accommodation is any adjustment to the work environment that will allow an employee to practice his or her religion. The need for religious accommodation may arise where an individual's religious beliefs, observances, or practices conflict with a specific task or requirement of the position or an application process. Accommodation requests often relate to work schedules, dress and grooming, or religious expression in the workplace. The employer must grant the accommodation unless it would pose an undue hardship. According to Title VII, employees cannot be discriminated against because of their religious beliefs in hiring, firing, and other terms and conditions of employment. Failure to comply with Title VII, other EEOC regulations, and related state laws that apply to employers with fewer than 15 employees can result in fines and penalties.

Instructions for Use

The top half of the Request for Religious Accommodation Form may be filled out by the supervisor of the requesting employee or an HR manager, based on the employee's input, and then signed by the worker. The workplace representative who would be approving the accommodation then needs to notate if the request for accommodation will be accepted and, if not, why the company cannot grant the request. Note: We recommend consulting with legal counsel or, if applicable, your contracted benefits provider prior to denying any accommodation request.

When to Use

The Request for Religious Accommodation Form should be provided to employees when they wish to request a religious accommodation for their current job position. Please note that the employee may not specifically use the term "accommodation" when verbally making their request. The employer is responsible for recognizing a request as such and engaging in the interactive process to determine whether a religious accommodation is required.

Retention Requirements

According to the EEOC, all personnel and employment records made or used by private employers-- including requests for religious accommodations (the Request for Religious Accommodation Form)-- must be preserved for one year from the date of making the record or the personnel action involved, whichever occurs later. When an employee is involuntarily terminated, the employer must retain the terminated employee's personnel employment records for one year from the date of termination.

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