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Leave Forms

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STANDARD LEAVE FORMS:  

DOP-L1 ​Leave with Pay
DOP-L2 ​Leave of Absence without Pay
​DOP-L3 ​Physician’s/Practitioner’s Statement
​DOP-L4
​Federal Family and Medical Leave Act (FMLA); State Parental Leave Act (PLA); Medical Leave of Absence without Pay
​DOP-L5 ​Federal Family and Medical Leave Act (FMLA) and/or Medical Leave of Absence without Pay - Supplemental Certification for Employee’s Serious Health Condition
DOP-L6 ​Federal Family and Medical Leave Act (FMLA) and/or State Parental Leave Act (PLA) - Supplemental Certification for Family Member’s Serious Health Condition
​DOP-L7 ​Federal Family and Medical Leave Act (FMLA) - Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave
DOP-L7V ​Federal Family and Medical Leave Act (FMLA) - Certificate for Serious Injury or Illness of Covered Veteran for Military Family Leave
DOP-L8
​Federal Family and Medical Leave Act (FMLA) - Certification for Qualifying Exigency for Military Family Leave  
DOP-L9 ​Federal Family and Medical Leave Act (FMLA) and/or State Parental Leave Act (PLA) - Notice of Eligibility and Rights and Responsibilities
​DOP-L10
​Federal Family and Medical Leave Act (FMLA) and/or State Parental Leave Act (PLA) - Designation Notice
DOP-L11 ​Application for Organ Donation/Testing Leave with Pay
​DOP-L12 ​Physician’s/Practitioner’s Statement for Organ Donation/Pre-Operative Testing
 

 

FORMS FOR USE WITH THE LEAVE DONATION PROGRAM:

Appendix A ​Application to Receive Donated Leave
Appendix B ​Notice of Eligibility to Receive Leave Donations
Appendix C ​Application to Donate Annual Leave
Appendix D ​Inter-Agency Donation Form
 

 

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