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DOL CERT OF SERIOUS INJURY FOR MILITARY FAM LOA.PDF
FMLA CERT FOR SERIOUS INJURY OF SERVICEMEMBER

UPDATED BY FEDS EFFECTIVE 01.01.2012 - TO BE USED IF AN EMPLOYEE REQUIRES OF A LEAVE OF ABSENCE TO CARE FOR AN ILL OR INJURED SERVICESMEMBER FOR MILITARY FAMILY LEAVE

Handle: Document-19355
Owner: Hanson, Jean (User-867, 07736:EVERETT)DS
Thursday, January 22, 2009 08:54:37 AM PST
Wednesday, September 27, 2023 02:15:55 PM PDT
Modified By: Mulvaney, Linnea (User-5348, 14156:EVERETT)DS
Locked By:
  • Certification for Serious Injury or
Illness of Covered Servicemember - - for Military Family Leave (Family andMedical Leave Act) U.S.
  • Department of Labor
Wage and Hour Division____________________________________________________________________________________________________________________________________________________________________________________________________________OMB Control Number: 1235-0003Expires: 2/28/2015Notice to the EMPLOYER INSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act(FMLA) provides that an employer may require an employee seeking FMLA leave due to a serious injury or illnessof a covered servicemember to submit ...
Allowed
Adobe Portable Document Format (.pdf) - application/pdf
FMLA Form - MIlitary Caregiver of a Current Servicemember - WH-385.pdf
No
4
377405
No
Appears In: LEAVE OF ABSENCE INFORMATION
Preferred Version: DOL CERT OF SERIOUS INJURY FOR MILITARY FAM LOA.PDF