1234 Street |
NAME of employer (or
supervisor/manager)
TITLE of employer (if
applicable)
NAME of company (if
applicable)
ADDRESS of employer
TOWN, STATE of employer
Dear Sir: [or Madame – May use personal name or last name with Mr./Mrs./Ms.]
Thank you for your accommodation to adapt my work schedule to allow for my requested religious days off. I realize that this accommodation now classifies me as a part-time worker. Because of this, I waive any claim to the following employee benefits:
- Weekly overtime
- Paid sick days
- Paid vacations
- Insurance coverage
- Paid maternity leave
- Paid holidays
At your request, I will provide [INSERT NAME OF BUSINESS] with a year of calendar pages marked with the needed days off.
I appreciate so much your consideration for my individual circumstances and your willingness to accommodate my needs for a different schedule. I enjoy my work for [INSERT NAME OF BUSINESS] and am thankful to be able to continue my employment here.
Sincerely yours,
[SIGN NAME HERE]
[TYPE NAME HERE]