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409.3E2 Employee Family and Medical Leave Request Form

Schleswig Community School District uses the forms found on the United States Department of Labor website for Family and Medical Leave Act.

 

 

·         WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition (PDF)

·         WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition (PDF)

·         WH-381 Notice of Eligibility and Rights & Responsibilities (PDF)

·         WH-382 Designation Notice (PDF)

 

Date Board Adopted 12/20/2010

Date Board Reviewed 2/14/2022