Fmla/njfla family/medical leave of absence request form name: rowan id: ext: last first mi date of hire: email: home phone: department: supervisor: i am requesting leave for the following time period: leave begin date: leave end date: phone number...
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Family and medical leave of absence request form name: i request leave of absence from: rdc: employee services 155 cottage street salem, or 97301 (503) 378-3622 (503) 378-6879 fax instructions to employees: this form must be returned to employee...
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Submit by email print form form # proconf rev. 8/07 hunterdon central regional high school request to attend a professional conference (all professional conference requests must be approved by the board of education. please check the motion date...
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Educational services center th 1350 west 106 street bloomington, mn 55431 4126 office of human resources phone 952.681.6440 fax 952.681.6449 .bloomington.k12.mn.us long term leave of absence request form (30 calendar days or more) name employee #...
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Helpings hands community development center, llc time off request form your request for time off must be submitted and approved by management in advance. employee information name: today s date: department: vacation days available: as of (date):...
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College of liberal arts department of philosophy travel and leave request form name (last, first) uin destination (city, state/country) start date end date account, if known (name/number) purpose & benefit: travel classification (check one)...
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Esd 113 form 5400-a33 page 1 of 1 bereavement leave request form educational service district 113 employees printed name: beginning date of leave: ending date of leave: check one: leave is for immediate family bereavement (maximum 5 days of paid...
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Bureau of land managementrequest for restoration of forfeited annual leaveunder the provisions of 5 u.s.c. 6304, it is requested that previously scheduled leave forfeited due toexigencies of the public service or due to sickness (injury) be...
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Health screening form for contracted workers and visitors name: ssn: date of birth: / / start date: / / healthcare provider must complete (not worker/visitor) initial one option in each section provide dates where indicated measles, mumps and...
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Richland parish school board sick leave severance request form i request pay for up to 25 accumulated sick leave days at the beginning of drop. i request pay for up to 25 accumulated sick leave days when my employment terminates. i request pay for...
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