Religious Accommodation Form printable pdf download

Religious Accommodation Form

Most written tests are held on Saturdays. If you cannot take the test on the announced test date

due to a conflict with a religious observance or practice, we will make arrangements for you to

take the test on a different date.

TO BE COMPLETED BY THE APPLICANT:

I hereby certify that I am a member of a church or a religious group that will observe the Sabbath

on _____________________________. It is contrary to the religious tenets of this of this church

or religious group for me to participate in a civil service examination during the Sabbath.

Name of religious organization

__________________________________________

Address of religious organization

__________________________________________

I further certify that I will neither seek nor receive any information regarding the general or

specific content of any examination held on this date.

__________________________________________

_____________________________________

PRINT NAME

DATE

__________________________________________

_____________________________________

SIGNATURE

EXAM DATE

__________________________________________

_____________________________________

SOCIAL SECURITY NUMBER

EXAM TITLE

H:forms/civilservice/Religious accomodation

Revised: 02/03

New letterhead- 112

Religious Accommodation Form