Forms for Applying for Paid Family & Medical Leave
Nov 09, 2020 · Paid Leave Customer ID number (if known): _____ Certification of birth . To be completed by a healthcare provider as defined in RCW 50A.05.010 to certify the date of birth in order for the applicant to qualify for family leave under Paid Family and Medical Leave. Please be sure to sign the form. Child’s da. te of birth: _____ / _____ / _____ ................
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