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Reason for requesting family leave (check one): To care for my child after birth or adoption or placement of a child with me for foster care (anticipated date of birth or placement )* To care for a family member who has a serious health condition* Relationship to you: spouse/partner parent son or daughter To attend to my own serious health condition resulting in my inability to perform the essential functions of my job* To attend to a qualifying exigency arising out of empl.

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