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Certification of Health Care Provider for Family Members Serious Health Condition (Family and Medical Leave Act)U.S. Department of Labor Wage and Hour Division___DO NOT SEND COMPLETED FORM TO THE
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How to fill out military-caregiver-leave-for-a-current-servicemember

01
Step 1: Obtain the military caregiver leave for a current servicemember form from your employer.
02
Step 2: Fill out your personal information, including your name, address, and contact information.
03
Step 3: Provide information about the current servicemember you will be providing care for, including their name, relationship to you, and the branch of the military they serve in.
04
Step 4: Specify the start date and end date of the leave period you are requesting.
05
Step 5: Describe the medical condition or injury that necessitates your caregiving responsibilities.
06
Step 6: Attach any supporting documentation, such as medical records or military orders.
07
Step 7: Sign and date the form.
08
Step 8: Submit the completed form to your employer for review and approval.
09
Step 9: Keep a copy of the filled-out form for your records.

Who needs military-caregiver-leave-for-a-current-servicemember?

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Military caregivers who are providing care for a current servicemember need to apply for military-caregiver-leave-for-a-current-servicemember.
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Military caregiver leave for a current servicemember is a provision that allows eligible employees to take leave to care for a covered servicemember with a serious injury or illness.
The eligible employees who need to take care of a covered servicemember with a serious injury or illness are required to file for military caregiver leave.
To fill out military caregiver leave, eligible employees must submit a completed request form to their employer, along with any required supporting documentation.
The purpose of military caregiver leave is to provide eligible employees with job-protected leave to care for a covered servicemember with a serious injury or illness.
The information that must be reported on military caregiver leave includes the name of the covered servicemember, the relationship of the employee to the servicemember, and a description of the serious injury or illness.
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