Religious Accommodation Request and Action Form

Author: Adam W. G. Freed, Jeremy M. Mittman and Anthony J. Oncidi, Proskauer Rose LLP

When to Use This Form

This form is for use by employees who seek to obtain a workplace accommodation based on religion. If an employee's or applicant's religious beliefs conflict with a job requirement, the individual may be entitled to a reasonable accommodation so long as the accommodation does not impose an undue hardship on the employer. Examples of accommodations may include job restructuring, job reassignment, modification of work practices, and allowing time off, or a combination of the above. This form should be made available by HR or the employer to all employees who seek to request a religious accommodation.

Below is a model form that should be further tailored to fit the employer's specific needs