Family and Medical Leave Application Request
FAMILY AND MEDICAL LEAVE APPLICATION REQUEST (See ADS Chapter 481 for detailed information) 1. Name. 2. Grade. 3. Position Title. 4. Series/Skill code. 5. Mission/Office Symbol. 6. Basic Pay Rate. 7. Reason for Application for Leave (check one of the following): a. Care for a newborn or newly adopted child (including foster children) * b. ................
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