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FMLA Request Form - roanokechowan

FMLA Request Form - roanokechowan 2025

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The document is a certification form for employers, employees, and health care providers related to the Family and Medical Leave Act (FMLA). It outlines the process for an employee to request leave to care for a family member with a serious health condition, requiring medical certification from a health care provider. The form includes sections for employer information, employee details, and specific medical information needed from the health care provider to support the leave request.

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