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Medical Leave Form

Type ID Label Required(yes/no) Options
text name Name no
text email Email no
text idnumber ID # no
text typeofleave Type of Leave(i.e., medical-self, family care, maternity,paternity) no
text startdate Tentative Leave Start Date no
text leavedate Tentative Leave End Date no
text phone Phone Number no
paragraph_text questions Questions and Comments: no      
Medical Leave - Donna Freeman

Medical Leaves of Absence

Types of Leave Programs

Usage of Leave Credits

Roles and Responsibilities

Assigned Leave Coordinator

Initiate a Leave of Absence


Leave Related Forms


Medical Leave Application

Rights and Responsibilities

Certification of Health Care Provider for Employee

Certification of Health Care Provider for Family Member

Certification of Health Care Provider for Paternity

Notice & Request Form


How to File a Claim


Catastrophic Leave

Option Sheet