Transcription of Family and Medical Leave Act Form - Welcome to NYC.gov
{{id}} {{{paragraph}}}
Example: barber
Family and Medical Leave Act Form - Welcome to NYC.gov
The City of New York Department of Citywide Administrative ServicesRequest for Leave under the Family and Medical Leave Act Employee's NameEmployee's Title Name of AgencyEmployee's Salary Work LocationI am requesting Leave for (Check one):1. Child care due to (Check one):a. Birth of childb. Placement of child for adoptionc. Placement of child for foster careNote:Child care Leave taken under the Family and Medical Leave Act must be concluded 12 months after the birth orplacement of the child. Taking child care Leave under the Family and Medical Leave Act does not diminish anemployee's right to child care Leave under the Citywide Agreement between the City of New York and DistrictCouncil 37, the " Leave Regulations for Employees Who are Under the Career and Salary Plan," and the LeaveRegulations for Management Employees.
The City of New York Department of Citywide Administrative Services Request for Leave under the Family and Medical Leave Act Employee's Name Employee's Title
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: