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File No. GBDHE1Certification of Health Care Provider for Employees Serious Health Condition (Family and Medical Leave Act)U.S. Department of Labor Wage and Hour Division DO NOT SEND COMPLETED FORM

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How to fill out wh-380-e - us department

01

To fill out WH-380-E form, follow these steps:

02

Use black ink and legible handwriting to fill in the form.

03

Begin by providing the employee's name, address, and phone number.

04

Specify the employee's position or job title.

05

Indicate the employee's work schedule.

06

State the date or dates of the requested leave.

07

Specify the type of leave being requested (e.g., sick leave, family leave, etc.).

08

Describe the reason for the requested leave and provide any necessary details.

09

Sign and date the form.

10

Provide the employer's name, address, and signature.

11

Submit the completed form as instructed by your employer.

Who needs wh-380-e - us department?

01

WH-380-E form is needed by employees who are requesting leave under the Family and Medical Leave Act (FMLA) from their employer in the US Department. This form is used to provide necessary information and documentation related to the employee's need for leave, such as the reason for leave and medical certification if applicable. It helps the employer review and process the employee's request for FMLA leave.

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What is wh-380-e - us department?

WH-380-E is a form used by the U.S. Department of Labor for employees to request leave under the Family and Medical Leave Act (FMLA) for a serious health condition.

Who is required to file wh-380-e - us department?

Employees of covered employers who wish to take FMLA leave for their own serious health condition must file WH-380-E.

How to fill out wh-380-e - us department?

To fill out WH-380-E, provide your personal information, details about the health condition, and a certification from your healthcare provider regarding the need for leave.

What is the purpose of wh-380-e - us department?

The purpose of WH-380-E is to determine eligibility for FMLA leave and to document the need for leave due to a serious health condition.

What information must be reported on wh-380-e - us department?

The form requires information such as employee details, the nature of the serious health condition, medical facts, and the health care provider's information.

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