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Medical Certificate Sample for Fit to Work  Form

Medical Certificate Sample for Fit to Work Form

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Return to Work Medical Certification FMLA Leave PART 1 TO BE COMPLETED BY EMPLOYEE please print or type Employee Name Date Leave Began First Name Middle Initial Last Name Employee Position Employee Signature Date I certify that on is able to resume Date Name of Employee performing the functions of his/her position with or without reasonable accommodation. Healthcare Provider Signature Date 2008 ADP Resource A5-121-0408. ...
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