Paid Family Leave Waiver for State Employees

1. Read through all pages of the document to find specific instructions if any
   
2. Enter requested information into the form
3. Print the form
4. Sign form on Employee's Signature line
5. Scan a copy of the signed form for your records
6. Send the original, completed, signed form to:

Form Type: Downloadable, PDF document

Requirements: Adobe Reader

Updated: February 2020

Owner:  State Benefits, Human Resources