Care List Form Submission Instructions
Please use this form to submit information to the Pattonville Human Resources Center regarding the death or serious illness of a current or former employee or the birth of a child of a current employee. Once a week, this information will be compiled and shared via email. Please complete all the required fields below so that full information can be shared.
Email address *
Name of Individual Submitting Information: *
Your answer
Name of Current/Former Employee who is Ill or has Passed Away or Current Employee who has had a Child: *
Your answer
Work Location of Current/Former Employee: *
Your answer
Position Held by Current/Former Employee: *
Your answer
Complete Information Regarding the Current/Former Employee to be Shared (illness, dates, arrangements, birth information, etc.): *
Your answer
Address for Cards/Donations:
Your answer
A copy of your responses will be emailed to the address you provided.
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