Religious Accommodation Request

Title VII religious accommodation request. Per Groff v. DeJoy (2023), employer must provide accommodation unless it imposes substantial increased costs.

Employee Information

• Employee Name
• Employee ID
  Optional if your organization uses employee IDs for routing.
• Work Email
• Department
• Manager Name

Request Details

• Type of Accommodation Requested
• Requested Start Date
• Requested End Date
  Leave blank if the request is ongoing or indefinite.
• How soon is this needed?
• Describe the accommodation you are requesting
  Briefly explain what change you are requesting and why it is needed.

Religious Practice or Observance Details

• What religious belief, practice, or observance is connected to this request?
  You may describe the belief or practice in your own words. Do not include more detail than needed.
• Is this request based on a sincerely held religious belief, practice, or observance?
• How often is the accommodation needed?
• How does the current policy or schedule affect your ability to work?
  Describe the impact only as it relates to the accommodation request.

Work Impact and Alternatives

• What accommodation do you think would work best?
• Are there other accommodations that would also meet your needs?
• Would the requested accommodation affect any essential job duties?
• If yes, which duties may be affected?

Supporting Information

• Upload any supporting documents
  Optional. Examples: schedule constraints, policy references, or other supporting materials.
• Additional comments

Acknowledgment and Consent

• I consent to HR reviewing this request and contacting me about it.
• I understand that my request will be handled confidentially to the extent possible, but may be shared with those who need to know to evaluate or implement an accommodation.
• I understand that requesting a religious accommodation will not result in retaliation.
• Signature
• Submission Date