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UNIVERSITY OF WISCONSIN SYSTEM CERTIFICATION BY HEALTH CARE PROVIDER FOR EMPLOYEE S SERIOUS HEALTH CONDITION FAMILY AND MEDICAL LEAVE ACT SECTION 1 For completion by the EMPLOYER Name of UW Institution UWUW Oshkosh Name of Employer Contact Address of Employer Katelyn Fenner 800 Algoma Blvd Oshkosh WI 54901 Employer Contact Phone 920 424-3008 Fax 920 424-2021 fennerk uwosh. If requested by your employer your response is required to obtain or retain the benefit of FMLA protections. Failure to...
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Section 1 for completion is the initial part of a form that needs to be filled out with personal information.
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Information such as name, address, date of birth, social security number, and immigration status must be reported on section 1 for completion.
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