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Kin Care Use Request Form

Kin Care v2.0

  • I was absent on the above date for a reason that qualifies as kin care. Note that absences that are covered by kin care include an illness of your child, parent, spouse, registered domestic partner, or registered domestic partner’s child. By signing below, I am requesting that the above absence be charged against my sick leave/PTO bank and be counted as kin care, and I am certifying that the time off stated above meets the definition of kin care. I understand that providing false information about the use of sick leave, including the use of sick leave for kin care, is a violation of company policy and that I may be disciplined or terminated for such a violation of company policy.
  • Date Format: MM slash DD slash YYYY
  • Drop files here or
    Accepted file types: jpg, png, pdf.
  • By clicking the box below I acknowledge that the information I am submitting is true and accurate.