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Get Personal Medical Leave Request Form (non Fmla) - Uab
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How to fill out the Personal Medical Leave Request Form (non FMLA) - Uab online
Filling out the Personal Medical Leave Request Form (non FMLA) is an important process for users needing to take a medical leave of absence. This guide provides step-by-step instructions to assist you in completing the form accurately and effectively.
Follow the steps to complete the form successfully.
- Click ‘Get Form’ button to obtain the form and open it for completion.
- Begin by entering your full name in the designated field to identify yourself as the applicant.
- Input your Employee Number and Office Phone Number, ensuring that the contact information is correct for any follow-up needed.
- Fill in your Department and Home Phone Number for reference throughout the process.
- Specify the start date of your requested leave using the format MM/DD/YYYY.
- Indicate the end date of your requested leave, also using the format MM/DD/YYYY.
- Provide a reason for your leave of absence by selecting one of the listed options: Illness/Injury or Pregnancy.
- Attach the required certification from your health care provider to validate your medical leave request.
- Sign and date the form at the bottom to confirm your request and acknowledgment of the terms regarding leave.
- Ensure your Department Supervisor fills in their information for approval, including their phone number and email address.
- Review the completed form for accuracy before you proceed to save changes, download, print, or share the form as required.
Complete your Personal Medical Leave Request Form online today to ensure timely processing.
When requesting a formal leave of absence, your letter should include the following: Request for a leave of absence. The dates you expect to be away from work. The date you plan to return to work. An offer to provide assistance, if feasible. Thanks for considering your request.
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