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Get Mta Leave Form 2018-2024

S a covered servicemember with a serious injury or illness. Section III – Request for Leave a.) Leave Beginning on ________________________ b.) Total # of Work Days ________ or and Leave Ending on ________________________ Total # of Work Weeks ________ Business Service Center HR-BEN-028 Page 1 of 2 Family and Medical Leave Act Application Form HR-BEN-028 Section IV – Type of Leave a) State the type of leave you are requesting: Continuous Intermittent Reduced Schedule (Intermitte.

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