12 -- Sample doctor's letter -- LOA (00340329).DOC
REQUEST FOR LEAVE OF ABSENCE. I am applying under the Family and Medical Leave Act4 Yes ( No (LONG TERM LEAVE OVER TEN DAYS Illness4 Without Pay (Maternity (Military3 (Personal (Without Pay)6 (Professional1 (Other (specify below)6 (SHORT-TERM LEAVE Annual (Sick Leave With Pay (Personal Leave With Pay (Personal Leave Without Pay (Professional1 ................
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