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Get Leave Account Format

Department. Employee PCN Class Title Department/Unit/Section Date of Hire Supervisor Date notified by employee REASON FOR LEAVE Adoption of child Placement of foster child Birth of child Serious health condition of employee Serious health condition of employees spouse, child or parent Provide description/details as appropriate: TYPE OF LEAVE REQUESTED Continuous Intermittent Reduced Hours If FMLA is approved, do you wish to use available sick leave and/or vacation time while on FMLA?.

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  • spouse
  • continuous
  • placement
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