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Request Family Medical Leave

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Family Medical Leave Request

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Family Medical Leave Time Reporting Form

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Family Medical Leave Medical Verification Form

Date Posted: September 9th, 2018 @ 1:02 PM
Last Updated: January 20th, 2021 @ 7:53 PM

Employee should complete this leave request, and then forward with appropriate medical or other verification along with a Family Medical Leave Time Reporting Form to the Disability Benefits Coordinator:

Mary Baptiste
Phone: 510-238-2270
Email: mbaptiste@oaklandca.gov