4321.1 form_6_20153.DOC



PERSONNEL SERVICES Form 4321.1

Absences, Leaves and Vacation

FMLA: Certification of Health Care Provider for Employee’s Serious Health Condition

The FMLA Certification of Health Care Provider for Employee’s Serious Health Condition Form WH-380-E Revised May 2015 is attached hereto. Copies may be made of the attached, or additional copies may be obtained from the U.S. Department of Labor, Wage and Hour Division.

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June, 2015 Copyright © 2015 Missouri Consultants for Education, Inc.

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