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Under the Family and Medical Leave Act eligible employees are entitled to up to twelve weeks of unpaid, job-protected leave for certain family and medical reasons. When possible, submit this request form to your supervisor at least 30 day before the leave is to commence. When submission 30 days in advance is impossible due to unavoidable circumstances, submit the request as early as is possible. When permitted under state or federal law, employer may deny or postpone leave for failure to.

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