Southwest – Employee Questionnaire Please fill out all sections to the best of your abilities. Name First Last PhoneEmail Address Street Address Address Line 2 City State / ProvinceAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Job Title Length at SWA Work Location Have you requested a religious exemption to the COVID-19 vaccine? Yes No When was the religious exemption submitted to SWA? MM slash DD slash YYYY What is the status of the religious exemption?SelectApprovedDeniedPendingHave you received any feedback on the exemption? (Please provide what they said.)Have you requested a medical exemption to the COVID-19 vaccine? Yes No When was the medical exemption submitted to SWA? MM slash DD slash YYYY What is the status of the medical exemption?SelectApprovedDeniedPendingHave you received any feedback on the exemption? (Please provide what they said.)
