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In accordance with the Family and Medical Leave Act of 1993 (FMLA), and all applicable amendments and regulations, eligible employees may be entitled to twelve (12) workweeks of unpaid, job-protected leave for certain family and medical reasons, or twenty-six (26) workweeks of leave to care for a covered military servicemember with a serious injury or illness. Eligible employees may use this form to request approval for that leave. 


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Human Resources - Personal Information Support
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