[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-306707-105":53,"doc-detail-306707-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","ddaa-e-form-a-family-and-medical-leave-application-form","DDAA-E Form A - Family and Medical Leave Application Form","","Family and Medical Leave Application Form A（DDAA-E Form A）用于员工提交请假申请，包含员工姓名、在学区内的职位、（如不同）家庭成员姓名以及请假原因选择。表格列出可适用情形：子女出生及第一年照护、收养或寄养、配偶/父母/子女严重健康状况、员工本人严重健康状况，以及因现役军人相关合格紧急事由或照护特定服务成员等。还说明医疗证明要求与提交期限，并提供预期休假时长、签名、日期、审批结果与学区存档信息。",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/ddaa-e-form-a-family-and-medical-leave-application-form/306707/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/ddaa-e-form-a-family-and-medical-leave-application-form/306707.png","ImageObject",442,249,{"name":88,"@type":89},"Margaret","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",8,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"哪些情形符合家庭与医疗假（Family and Medical Leave）？","Question",{"text":109,"@type":110},"表格列出多类符合条件的情形，包括子女出生及第一年照护、收养或寄养、配偶/父母/子女的严重健康状况、员工本人严重健康状况、合格紧急事由（与现役军人相关），以及照护符合条件的服务成员等。","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"需要提交医疗证明（medical certification）吗？",{"text":114,"@type":110},"若原因属于(a)或(b)，不需要医疗证明。若原因属于(c)或(d)，员工须在学区主管（Superintendent）要求认证后的15个日历日内，由员工或家庭成员的医疗服务提供者完成并提交证明确认。",{"name":116,"@type":107,"acceptedAnswer":117},"如何填写预期休假时长（anticipated duration）？",{"text":118,"@type":110},"需附上预计使用家庭与医疗假的时间估计，包括缺勤的时间与日期安排，并说明预计开始日期与整体预计时长。","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},306707,1790201293,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":4},137451207643,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Descriptor Code: DDAA-E Form A  \nFAMILY AND MEDICAL LEAVE APPLICATION  \n1. Employee’s Name:    \n2. Employee’s Position in District: Building:   \n3. Patient’s Family Member Name (if different from employee):    \n4. Family and Medical Leave is available in one or more of the following instances:  \na. the birth and first-year care of a son or daughter;  \nb. the adoption or foster placement of a child;  \nc. the serious health condition of an employee’s spouse, parent, or child;  \nd. the employee’s own serious health condition that makes the employee unable to perform his/her essential job functions;  \ne. because of any qualifying exigency, arising out of the fact that a spouse, son, daughter, or parent of the employee is on active duty (or has been notified of an impending call or order to active duty) in the Armed Forces in support of a contingency operation.  \nf. to care for a covered service member if the eligible employee is the spouse, son, daughter, parent, or next of kin of the covered service member.  \nReason for the leave: Does the patient’s condition qualify under any of the categories described above? If so, please check the applicable category.  \n(a)   (b)   (c)   (d)   (e)   (f)   None of the above:    \n5. Medical certification: A medical certification form is not necessary in the case of categories (a) or (b) . When the reason for the leave is (c) or (d), an employee must support a request for a Family and Medical Leave with a certificate completed by the employee’s or family member’s health care provider within 15 calendar days after the Superintendent requests certification. Failure to provide the certification may result in a denial of the leave request.  \n6. The U.S. Department of Labor (attached forms) will be used as the District’s medical certification form.  \n7. Anticipated duration (including anticipated commencement date): Please attach an estimate of the time you will be using as Family Medical Leave, including a schedule of times and dates of absence from your job duties.  \n8. Other information pertinent to this application:  \nEmployee’s Signature:   Date:    \nThe Dickinson Public School District has considered this application for Family and Medical Leave and the request is 􀂉approved 􀂉 not approved. A copy of this application will be given to the Director of Personnel and will be placed in the employee’s personnel file.  \nSuperintendent’s/Human Resource Director’s Signature:   Date:    \nDickinson Public School Date Issued: 12/4/00  \nDistrict \\#1 Date of Last Amendment: 11/29/2018","cbCaik8WrMbUuNKp","https://ap.wps.com/l/cbCaik8WrMbUuNKp","pdf",35638,"English","# Family and Medical Leave Application\n## Employee information\n## Leave eligibility categories\n## Reason and medical certification rules\n## Anticipated duration and other information\n## Approval and signatures","[{\"question\":\"哪些情形符合家庭与医疗假（Family and Medical Leave）？\",\"answer\":\"表格列出多类符合条件的情形，包括子女出生及第一年照护、收养或寄养、配偶/父母/子女的严重健康状况、员工本人严重健康状况、合格紧急事由（与现役军人相关），以及照护符合条件的服务成员等。\"},{\"question\":\"需要提交医疗证明（medical certification）吗？\",\"answer\":\"若原因属于(a)或(b)，不需要医疗证明。若原因属于(c)或(d)，员工须在学区主管（Superintendent）要求认证后的15个日历日内，由员工或家庭成员的医疗服务提供者完成并提交证明确认。\"},{\"question\":\"如何填写预期休假时长（anticipated duration）？\",\"answer\":\"需附上预计使用家庭与医疗假的时间估计，包括缺勤的时间与日期安排，并说明预计开始日期与整体预计时长。\"}]","DDAA-E Form A - Family and Medical Leave Application Form | PDF",1789840225]