Note: You might want to start with the above form. This is NOT a "magic bullet," and most employers will most likely refuse to sign it. But this is an excellent legal start in case you do need to handle this with an attorney. Make certain you record your interaction with the employer (audio/or video). Let them know you are recording it for legal purposes. Be courteous, but resolute. After all, they are threatening you with losing your livelyhood if you refuse to accommodate their irrational order for you to take an experimental and non-FDA approved drug/gene-therapy/vaccination that even the federal government is not allowed to force upon you.

If your employer/HR Dept. actually reads the form and/or fills it out, it may very well settle the matter right there on the spot. In any case, you'll have the filled out form, or their refusal - which you should note with the recording and then you sign every line with your name and the words "Employer Refused to Sign". Note the time, date, and name of person you approached with the form. Make certain you take the recording and this form to your attorney on your very first visit! Attorneys and legal groups who might assist you in your case are listed in the links below.

NEW! added 9/10/21 - LAW FIRMS AND LAW SUITS THAT CAN HELP YOU WITH VAX AND MASK MANDATES
https://fightthemandates.godaddysites.com/

NEW! added 8/14/21 - MILITARY RELIGIOUS EXEMPTION EXAMPLE TEMPLATE that are handling vaccine abuse and injury cases
http://www.carlgallups.com/vaxrefusal/religiousexemptionexample.doc

ATTORNEYS IN EACH STATE that are handling vaccine abuse and injury cases
https://uscfc.uscourts.gov/sites/default/files/Vaccine%20Attorneys.pdf

CLASS ACTION SUIT through Front Line Doctors. You can sign up NOW - confidential, they WILL be in touch, and there is no legal fee for you.
https://americasfrontlinedoctors.org/forms/plaintiff/

CLASS ACTION SUIT through Liberty Council - Christian Lawyers - Nationally renowned. CALL NOW:(407) 875-1776 | Email:Liberty@LC.org

FILING YOUR OWN SUIT prepared by a Harvard Law Grad and Current Candidate for Congress - all the documents are prepared and ready for you to download and customize to your particular case. No Charge.
https://ethosthemovie.com/vaccine-mandates

ARM YOURSELF WITH THE LATEST LEGAL INFO! in an easy-to-read and straight forward format. You might want to print this and take it to your attorney as well. Be armed with the proper information.
https://healthfreedomdefense.org/wp-content/uploads/FAQ-Vaccine.pdf

FORM FOR EMPLOYEES WHOSE EMPLOYERS ARE REQUIRING THE VAX
https://pandemic.solari.com/form-for-employees-whose-employers-are-requiring-covid-19-injections/

FORM FOR STUDENTS ATTENDING COLLEGE OR UNIV THAT REQUIRES THE VAX
https://pandemic.solari.com/form-for-students-attending-colleges-or-universities-requiring-covid-19-injections/

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Additional LEGAL RESOURCES if your employer wants to fire you for not taking an Experimental/non-FDA approved "Vaccine":

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If you find yourself in a predicament with a company that refuses to hear you out, does not provide you with required information, or threatens termination of your employment, here are a few potential resources for attorneys:

America's Frontline Doctors (AFLDS): AFLDS provides an intake form on their site that you can fill out and submit; they will search for an attorney in your area who is taking on this type of case. There is a small fee for the search, and of course, attorneys have their own fees. On July 19, 2021, AFLDS also filed a motion seeking immediate injunctive relief to halt administration of EUA Covid-19 injections to anyone age 18 and younger; anyone who has recovered from Covid; and all Americans who have not received informed consent as defined by federal law.
https://www.americasfrontlinedoctors.org/legal/vaccines-the-law

Health Freedom Defense Fund: This nonprofit is working to address unethical and unlawful mask, testing, and vaccine mandates through focused legal actions. Resources for employees include a Notice to Employers ("Vaccine Notice") that compulsory Covid-19 vaccination imposed by employers on employees violates federal law.
https://healthfreedomdefense.org/resources/

Informed Consent Action Network (ICAN): ICAN's legal team is offering to assist employees who are being required by an employer to receive Covid-19 injections.
https://childrenshealthdefense.org/defender/forced-to-get-covid-vaccine-ican-may-be-able-to-help/

State-level: If you find yourself needing an ATTORNEY FOR VACCINE INJURY CASES, you can try looking through this state list:
https://uscfc.uscourts.gov/sites/default/files/Vaccine%20Attorneys.pdf



MORE RESOURCES

Fed. Law Regarding Religious Discrimination in the Workplace (For those seeking a religious exemption from taking an experimental vaccine HERE

More resources for Military and Religious Exemptions to Covid Experimental Vaccines HERE

( Aug. 6, 2021) Rep. Mark Green: Mandatory Vax for Troops Before FDA Approval Is 'Against the Law' "To mandate the vaccine before FDA approved, the president can do so only in connection with service members' participation in a "particular military operation." 10 U.S. Code 1107.
Read the article HERE

LIBERTY COUNCIL (Nationally Renowned Christian Attorneys) CALL or WRITE THEM - They will take your info to possibly defend you in a Class Action Suit.
Post Office Box 540774
Orlando, FL 32854
(407) 875-1776
Email: Liberty@LC.org

More Resources Prepared by a Harvard Law Grad so that you can proceed legally HERE