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FAX COMPLETED FORM TO HR: 8155969 LEAVE OF ABSENCE APPLICATION Name Shift Dept. Position Date Employment Status (check one): FT PT PRN Address (City, ST, Zip) Home Phone # Cell Phone # Employee #
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Once you have completed filling out the form, review it one more time to ensure that all the information is correct and properly entered.
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If necessary, make copies of the completed form for your records or for any additional parties that may require a copy.
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Finally, locate the fax number provided on the form or gather the necessary recipient information. Insert the completed form into a fax machine or use an online fax service to send the form securely to the intended recipient.

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