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Get Fit For Duty Form

FITNESS FOR DUTY STATEMENT (Family and Medical Leave Act) PART A: TO BE COMPLETED BY EMPLOYER ATTENTION HEALTH CARE PROVIDER: Employer: Address: City of Chicopee Human Resources Department 274 Front.

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  1. Click the orange Get Form button to start enhancing.
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  4. Be sure the info you add to the Fitness For Duty Form is updated and accurate.
  5. Add the date to the template with the Date tool.
  6. Select the Sign button and make an e-signature. Feel free to use 3 available options; typing, drawing, or capturing one.
  7. Check once more each area has been filled in correctly.
  8. Click Done in the top right corne to save or send the document. There are many alternatives for getting the doc. As an instant download, an attachment in an email or through the mail as a hard copy.

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