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DOL MEDICAL DOC REVISED.PDF
FMLA CERT FOR EMPLOYEE'S HEALTH CONDITION

UPDATED BY FEDS EFFECTIVE 01.01.2012 - TO BE USED IF AN EMPLOYEE REQUIRES A MEDICAL LEAVEOF ABSENCE OF MORE THAN FIVE WORKING DAYS

Handle: Document-19352
Owner: Hanson, Jean (User-867, 07736:EVERETT)DS
Thursday, January 22, 2009 08:51:15 AM PST
Wednesday, September 27, 2023 03:23:53 PM PDT
Modified By: Mulvaney, Linnea (User-5348, 14156:EVERETT)DS
Locked By:
  • ______________________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________Certification of Health Care Provider for U.S.
  • Department of Labor
Employee’s Serious Health Condition(Family and Medical Leave Act) Wage and Hour Division OMB Control Number: 1235-0003Expires: 5/31/2018SECTION I: For Completion by the EMPLOYERINSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employermay require an employee seeking FMLA protec...
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FMLA FORM Certification of Health Care Provider for Employee's Serious Health Condition under FMLA WH-380-E.pdf
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291463
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Appears In: LEAVE OF ABSENCE INFORMATION
Preferred Version: DOL MEDICAL DOC REVISED.PDF