Layoff During Leave Inquiry Form
Submit your inquiry if you experienced or were notified of a layoff during a period of approved leave.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Department
Position/Job Title
Type of Leave
*
Please Select
Sick Leave
Maternity/Paternity Leave
Annual/Vacation Leave
Unpaid Leave
Other
Leave Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Leave End Date (if applicable)
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date of Layoff Notification
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How were you notified of the layoff?
*
Email
Phone Call
Letter/Mail
In Person
Other
Do you know the stated reason for your layoff?
*
Yes
No
If yes, please specify the stated reason for your layoff.
Please provide any additional details about your situation.
Upload any supporting documents (e.g., leave approval, layoff notice, correspondence)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Signature
*
Submit Inquiry
Submit Inquiry
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