WFN Staff Vaccination Attestation - Westbank First Nation

* səxʷk̓ʷul̓m/Worker Name:

* Job Title:

* Department:

* Please choose one of the following options: As of today's date, I am: I am Fully Vaccinated meaning I have received two doses of Health Canada or WHO-approved vaccines or a single dose of the Janssen (Johnson and Johnson) COVID-19 vaccine.
I am Partially Vaccinated (i.e. I have received one dose of a Health Canada or WHO-approved vaccine and I understand that I must receive my second dose within six weeks of the date of this Attestation and agree that I will provide a revised Attestation indicating that I am fully vaccinated.
I am Unvaccinated.
I decline to provide my vaccination status.
I request an exemption from being vaccinated for religious or medical reasons. I understand that Westbank First Nation may require further information from me regarding the nature of my exemption which, may include documentation from my physician or religious leader, in order to determine my eligibility request for exempt status.

If you are partially vaccinated, what date did you receive your vaccine?

Open the calendar popup.

* I understand that Westbank First Nation is relying on my truthful attestation to provide a safe working environment for Workers, Members, clients, and guests with whom we interact regularly, and as otherwise set out in this Attestation, and I understand that making a false Attestation may have consequences on my employment, up to and including termination.