Path Home About State Agency Divisions Human Resources Family and Medical Leave Application Designation Notice
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Designation Notice

Please complete the following form and submit with the FMLA Request Form to Human Resources:

Designation Notice FormĀ  WH-382

FMLA Personnel Policy

Family and Medical Leave Act (FMLA) Request Form

Please submit the completed FMLA Request Form and supporting documentation for eligible circumstance to Human Resources for verification and approval.

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