Ufcw sick leave form 2026

1. Click ‘Get Form’ to open the UFCW Sick Leave form in our editor.
2. Begin by filling out Part 1, Employee Information. Enter your last name, first name, date of birth, and social security number. Ensure your mailing address is accurate and check if it has changed.
3. In section 1-B, provide the first date you were absent due to disability and your expected return-to-work date. Indicate if the injury occurred on the job and specify the injury date if applicable.
4. Complete section 1-C regarding doctor visits during your disability. In section 1-D, describe your disability briefly and sign where indicated.
5. Part 2 must be filled out by your employer. They will provide details about your work schedule and confirm any absences related to your disability.
6. If necessary, ensure that Part 3 is completed by your physician for verification of your condition.

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