Az leave 2025

1. Click ‘Get Form’ to open the az leave document in the editor.
2. Begin by entering your personal information in the 'Injured Worker' section, including your ICA Claim number, date of injury, and carrier claim number. Ensure all fields are filled out completely for efficient processing.
3. Provide your social security number as required. This is essential for identifying your records within the Claims Division.
4. In the 'Reason for Requesting to Leave the State' section, clearly state your reason for leaving. This helps expedite your request.
5. Fill in the dates you plan to leave and return under 'Leaving On' and 'Returning On'.
6. Enter your out-of-state address and contact phone number to ensure proper communication during your absence.
7. List your attending physician's name and phone number for any necessary follow-ups.
8. Finally, sign and date the form at the bottom, ensuring that all information is accurate before submission.

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