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COUNTY OF GLENN
2022 COVID-19 California Supplemental Paid Sick Leave
Request and Coordination of Benefits Authorization Form
On February 9, 2022, the Legislature passed SB 114 providing for a new
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How to fill out covid-19 leave request form
How to fill out covid-19 leave request form
01
Obtain a copy of the covid-19 leave request form from your employer or HR department.
02
Fill out your personal information including your full name, employee ID, department, and contact information.
03
Provide details on the dates you are requesting leave for and the reason for the leave (covid-19 related).
04
Include any relevant documentation such as a doctor's note or testing results if required.
05
Sign and date the form before submitting it to the appropriate person or department for approval.
Who needs covid-19 leave request form?
01
Employees who need to take time off from work due to covid-19 related reasons.
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What is covid-19 leave request form?
The covid-19 leave request form is a document that employees use to formally request leave due to circumstances related to the COVID-19 pandemic, such as illness, quarantine, or caregiving responsibilities.
Who is required to file covid-19 leave request form?
Employees who are affected by COVID-19 and wish to take a leave of absence for related reasons are required to file a covid-19 leave request form.
How to fill out covid-19 leave request form?
To fill out the covid-19 leave request form, employees should provide their personal information, specify the reason for the leave, indicate the dates of absence, and sign the form before submitting it to their employer or HR department.
What is the purpose of covid-19 leave request form?
The purpose of the covid-19 leave request form is to document an employee's request for leave due to COVID-19 related reasons and to ensure that the employer is aware of the employee's situation and can manage their absence appropriately.
What information must be reported on covid-19 leave request form?
The information that must be reported on the covid-19 leave request form typically includes the employee's name, contact information, reason for leave, date of requested leave, and any relevant documentation concerning their COVID-19 situation.
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