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Intent to Return and Fitness for Duty/Medical Release FMLA - Form 3 SECTION 1 Instructions for the DEPARTMENT A copy of the essential job functions and regular work schedule/hours must be attached. SECTION 2 To be completed by the EMPLOYEE Name of Employee Print Employee Contact Information phone email If leave was for a continuous block of time and my health care provider has released me to return to work I intend to return to work as scheduled. If no I am stating I do not intend to return to work and I am resigning my employment with Indiana University. o Yes o No I o authorize o do not authorize check one the health care provider identified below to provide the information requested on this form for the purposes of determining my fitness for duty and for a designated IU human resources professional to contact the health care provider to authenticate and/or clarify the information if needed* I understand that if I do not agree to this authorization my return to work may be delayed or....

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232