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For example: One (1) day per week for four (4) hours to attend appointments. |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n|  |  |  |  |  |\n| For leaves due to your own or a Family Member’s Serious Health Condition, a Medical Certification form is required. Please contact HR to obtain the form.\u003Cbr> A completed Medical Certification form is attached.\u003Cbr> I will submit a Medical Certification form within 15 days to Human Resources. |  |  |  |  |\n| A leave of absence is normally leave without pay. Paid leave (accrued sick leave or vacation) may be substituted for all or a portion of the unpaid leave in according with appropriate policies/contracts.\u003Cbr> I wish to use paid leave as indicated below: (attach additional sheets if necessary)\u003Cbr>(MM/DD/YY) (MM/DD/YY) OR\u003Cbr>  Hours of accrued sick Begins on   and ends on   Use all Available \u003Cbr>  Hours of accrued vacation Begins on   and ends on   Use all Available \u003Cbr>  Hours of accrued Comp Begins on   and ends on   Use all Available  |  |  |  |  |\n| I have read and understand the above information. I acknowledge that it is my responsibility to furnish the required medical certification within 15 calendar days and to communicate with Human Resources regarding my leave status.\u003Cbr>Employee’s Signature Date |  |  |  |  |","cbCaicJnHXKxmE1U","https://ap.wps.com/l/cbCaicJnHXKxmE1U","pdf",231644,"English","# Section I - To be Completed by the Employee\n## Employee information\n## Request type and reason\n## Type of leave requested\n## Medical certification and compliance\n## Paid leave substitution and employee acknowledgement","[{\"question\":\"员工需要在请假开始日期前多久提交表格？\",\"answer\":\"需在所申请的请假开始日期前30天完成并提交给人力资源代表。\"},{\"question\":\"如果因自身或家庭成员的严重健康状况请假，需要提供什么文件？\",\"answer\":\"表格说明此类请假需要Medical Certification（医疗证明）表格；需联系HR获取，并可在规定期限内提交。\"},{\"question\":\"请假通常是无薪还是带薪？如可带薪替代如何选择？\",\"answer\":\"通常请假为无薪（leave without pay），但可能根据相关政策/合同以已累积的sick leave或vacation替代。员工需按表格指明使用带薪假期的开始与结束日期并注明可用小时/天数。\"}]","EMPLOYEE LEAVE OF ABSENCE REQUEST FORM - Complete and Return to HR 30 Days Prior | PDF",1789843524]