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LEAVE REQUEST FORMEMERGENCY PAID SICK LEAVE AND EXPANDED FAMILY AND MEDICAL LEAVE NameEmployee Department/campusPositionEmailPhone numberDateDuration of leave (specify dates requested)Leave benefits
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How to fill out i request epsl for

01
Determine if you are eligible for Emergency Paid Sick Leave (EPSL) as per the guidelines provided by the Department of Labor.
02
Fill out the required form provided by your employer or download it from the official Department of Labor website.
03
Provide all necessary personal information such as name, employment details, and reason for requesting EPSL.
04
Clearly state the dates for which you are requesting EPSL and specify whether it is for yourself or to care for a family member.
05
Sign and date the form before submitting it to your employer for approval.

Who needs i request epsl for?

01
Employees who are unable to work or telework due to specific COVID-19 related reasons.
02
Employees who need to take time off to care for themselves or a family member who is affected by COVID-19.
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The EPSL request is for requesting Emergency Paid Sick Leave.
Employees who are eligible for Emergency Paid Sick Leave are required to file the EPSL request.
Employees can fill out the EPSL request form provided by their employer or HR department.
The purpose of the EPSL request is to request paid sick leave for qualifying reasons related to COVID-19.
The EPSL request must include the employee's name, date of request, reason for leave, and supporting documentation.
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