This form is an Employment Application. The form provides that applications are considered without regard to race, color, religion, or veteran status.
Employee Request Form For Fmla Leave In Contra Costa
Category:
State:
Multi-State
County:
Contra Costa
Control #:
US-00413
Format:
Word;
Rich Text
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I understand that I am required to provide timely medical or other valid certification for my leave request, also notify my department leave. Providing appropriate forms to employees. 2.Determining FMLA leave eligibility and communicating results with employees and Personnel Division. 3. Complete the "Employee Information" section. Select the type of leave being requested and complete that section. An eligible employee is one who has completed 12 months of service. Employees must submit a written request to District Human Resources requesting Family Leave. Request for Joinder of Employee Benefit Plan Order. FL-374, Notice of Appearance and Response of Employee Benefit Plan.