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COVID-19 Vaccine Employment Eligibility Form

New Yorkers:

We are committed to ensuring that all New Yorkers can conveniently access the safe COVID-19 vaccines at no cost to you.

For information about who is currently eligible and where to get the vaccine, please visit the NYC Vaccine Command Center website.

Who is eligible?
New York State has declared which New Yorkers are currently eligible for the vaccine. To see if you are eligible please visit the NYC Health Department website.

How to make an appointment?
Eligible New Yorkers can find vaccination sites and make an appointment online at vaccinefinder.nyc.gov or by calling 877-VAX-4NYC (1-877-829-4692).

If eligible based on your job, you must attest that this job requires you to have in-person contact with members of the public or with co-workers, or that you are unable to work remotely. When you go to your vaccine appointment you must also provide proof of employment in New York. All of the below are acceptable proof of employment:
    •  Employee ID card
    •  Recent pay stub
    •  Proof of work via an application (e.g., Uber, Lyft, DoorDash, etc.)
    •  Signed letter from your employer or affiliated organization

Getting a letter from your employer or affiliated organization

If your employer has not or cannot provide you with a letter confirming your employment, this website will help you create a customized letter based on whether you
    •  Work for a business or organization, or
    •  Work for yourself, or
    •  Work for another person or individual, or
    •  Can have your job confirmed by an affiliated organization

This letter (printed or as a digital version displayed on your phone) can be used as proof of employment in New York. You can also use this letter as a template to create your own document – if you do create your own version, please include: 
    •  The name of the person being vaccinated
    •  The job of the person being vaccinated (eligible categories are listed here)
    •  The name of the business, organization, or individual the person being vaccinated works for 
    •  The name of the city the person being vaccinated works in
    •  The name of the person signing the document, and their signature
    •  The date

These letters will not be used as legal proof of your employment status, and they will not be collected. Their only purpose is to confirm your eligibility for vaccination. The information you provide to complete these letters is not captured or saved anywhere. 

Thank you for your partnership in helping us stop COVID-19 in its tracks! 

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