Employee Leave of Absence (LOA) Request 
Please complete the following electronic form if you are requesting a LOA. Requests should be submitted at least 30 days prior to leave (unless leave is unforeseen, in which case submit the form as soon as practical). Leave requests that qualify under the Family and Medical Leave Act (FMLA) will follow all required guidelines and timelines.
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Email *
Which year are you requesting an LOA *
Employee 6-digit LMSV ID (if you don't know your Employee ID, leave blank):
Last Name: *
First Name: *
Best phone number to reach me *
Site: *
Time off work is expected to be: (select most appropriate) *
What is your classification *
What is your Job Title *
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