Get University Of Chicago Victims Economic Security And Safety Act (vessa) Leave Of Absence Request Form 2015-2025

The University Of Chicago Victims Economic Security And Safety Act (VESSA) Leave Of Absence Request Form is an important document designed to support employees affected by domestic or sexual violence. This guide provides clear, step-by-step instructions to help you complete the form online with ease.

Follow the steps to successfully complete the VESSA Leave Of Absence Request Form.

1. Begin by clicking the ‘Get Form’ button to access the VESSA Leave Of Absence Request Form and open it in your browser or preferred digital format.
2. Fill in your employee name in the designated field to ensure your request is linked to your profile.
3. Enter your Social Security Number (SSN) in the appropriate box, ensuring confidentiality and accuracy.
4. Provide your home address, including city, state, and zip code, to facilitate communication regarding your leave request.
5. Indicate your job title and department to clarify your role within the organization.
6. In the section for the reason for leave request, select the applicable option regarding domestic or sexual violence, specifying if it relates to yourself or a family/household member, and provide the name and relationship of the individual involved.
7. State the expected duration of your leave by filling in the start and end dates in the format month/day/year.
8. If you anticipate needing intermittent leave, describe the expected frequency and duration in the provided space.
9. In the section related to benefits, indicate your preference for using paid time off during your leave by choosing from vacation, personal holidays, and sick leave, as applicable.
10. Request to continue your benefits during the leave by checking the relevant boxes for medical, dental, life, personal accident, and long-term disability insurance.
11. Read the terms provided about your leave, and review to ensure that all information is accurate and complete.
12. Sign the form with your name and the date to certify the accuracy of the information provided.
13. After filling out the form, save any changes and prepare to submit your request to HR-Leave Administration at least 48 hours prior to your leave.

Complete your VESSA Leave Of Absence Request Form online today and ensure your rights and benefits are protected.