Name: _______________________ Department: ___________________

Date of request: _________________________________

Immediate supervisor: __________________________________

Requested accommodation (job change, schedule change, dress/appearance code

exception, vaccination exemption, etc.):

_Exemption from work on Sundays for religious practice_____________________

_________________________________________________________________

Length of time the accommodation is needed: __Ongoing___________________

Describe the religious belief or practice that necessitates this request for
accommodation:

_As a Christian my personal belief is to gather with fellow believers to worship together
on Sundays. This is a long-standing belief that has been practiced by believers in Jesus
Christ since the early Church. There are allowances made in the Civil Rights Act of
1964 that allows for employees who request such an exemption.
________________________________________________________________

Describe any alternate accommodations that might address your needs:

_Availability to work on any day except Sunday. __________________________

_________________________________________________________________

_________________________________________________________________

I have read and understand United States Postal Service’s policy on religious
accommodation. My religious beliefs and practices, which result in this request for a
religious accommodation, are sincerely held. I understand that the accommodation
requested above may not be granted but that the company will attempt to provide a
reasonable accommodation that does not create an undue hardship on the company. I
understand that United Postal Service may need to obtain supporting documentation
regarding my religious practice and beliefs to further evaluate my request for a religious
accommodation.

Employee signature: _____________________________ Date: _________________