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CITGO FMLA (I-223) 2007-2025 free printable template

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CIT GO Petroleum Corporation Certification of Fitness for Duty To be completed by Health Services: Employee: Personnel No: Location: Supervisor: Job: Supervisor Tel: This Employees Essential Functions
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How to fill out CITGO FMLA (I-223)

01
Obtain the CITGO FMLA (I-223) form from the official CITGO website or HR department.
02
Read the instructions carefully to understand the requirements and guidelines.
03
Fill out your personal information, including your name, address, and employee ID on the top of the form.
04
Indicate the reason for your FMLA request by selecting from the provided options.
05
Provide details about your serious health condition or the condition of a family member, if applicable.
06
Include the dates for which you are requesting leave.
07
Sign and date the form at the bottom to certify the information is accurate.
08
Submit the completed form to your supervisor or HR department, ensuring you keep a copy for your records.

Who needs CITGO FMLA (I-223)?

01
Employees who have worked for CITGO for at least 12 months and have accumulated sufficient hours.
02
Individuals who are experiencing a serious health condition that requires extended time off.
03
Employees needing to care for a family member with a serious health condition.
04
Those who are expecting to bond with a newborn or newly adopted child.
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Headquartered in the Energy Corridor area of Houston, it is majority-owned by PDVSA, a state-owned company of the Venezuelan government (although due to U.S. sanctions in 2019, they no longer economically benefit from Citgo). 1910 in Bartlesville, Oklahoma, U.S.
The Company is committed to having a workforce and workplace that is free from unauthorized, prohibited, illegal or controlled substances, including alcohol, drugs and other chemicals.
"CITGO's current branded sales exceed our in-house production capabilities, straining our resources and potentially compromising our ability to provide optimum service to our customers.
CITGO has 3,700 employees and is owned by CITGO Holding, Inc., an indirect, wholly owned subsidiary of Petróleos de Venezuela, S.A. (PDVSA), the national oil company of the Bolivarian Republic of Venezuela. CITGO owns and operates three highly complex crude oil refineries located in Lake Charles, La.
CITGO means Citgo Petroleum Corporation, a Delaware corporation, and its affiliates and subsidiaries, as applicable. CITGO shall have the meaning set forth in the Recitals to this Agreement; CITGO means CITGO Petroleum Corporation, a defendant in xx IV.
The decision on Thursday is the latest blow to Venezuela's efforts to avoid a breakup of Citgo, which is owned by state oil company Petroleos de Venezuela (PDVSA. UL) and controlled by political opponents of the South American country's socialist government.

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CITGO FMLA (I-223) is a form used by employees to request leave under the Family and Medical Leave Act (FMLA) for specific family or medical reasons.
Employees of CITGO who need to take leave for qualifying family or medical reasons are required to file CITGO FMLA (I-223).
To fill out CITGO FMLA (I-223), employees must provide their personal information, details of the leave requested, the reason for the leave, and any required documentation to support their request.
The purpose of CITGO FMLA (I-223) is to formally document an employee's request for leave under FMLA to ensure compliance with the law and protect the employee's job during their absence.
The information that must be reported on CITGO FMLA (I-223) includes the employee's name, contact information, dates of leave, reason for leave, and any supporting medical documentation if applicable.
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