Letter waiving employee benefits

1234 Street Any town, Any State CURRENT DATE

                                                                                                                   

 
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]