Supplemental Pay Leave Request Form for Union Employees

I elect to receive FMLA correspondence electronically and understand that it will be sent to my personal email account. I further understand and agree that I will be responsible to check my email regularly, including any applicable SPAM or junk folders, for FMLA correspondence and other leave related communications. I may exercise my right to affirmatively request paper copies or discontinue electronic delivery at any time by contacting Leave Administration at HR_FMLA@ur.rochester.edu.

I do not wish to receive FMLA correspondence electronically and agree to receive such information via U.S. mail.

Supplemental Pay Leave Request Form for Union Employees

This form is for SEIU/1199 union members (BU2/BU4) only.

Employee information

Supplemental bank options

Accrual options

Electronic Receipt of FMLA Correspondence While on Leave of Absence

Attestation