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Get University Of Utah Electronic Fmla Form

Human Resources Division 420 Wakara Way Suite 105 Salt Lake City Utah 84108 Fax 801 585-7375 Request for Leave Under the Family and Medical Leave Act of 1993 FMLA Employee Information Name Employee ID Address City Email Address Home Phone Department Work Phone Supervisor s Name Zip Supervisor s Phone Number Payroll Reporter s Name St Reason for FMLA Request Use of Vacation Accruals Maternity Paternity Adoption or Foster Care Placement Serious .

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