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MLPD Sick/Injury Form

  1. Type of Leave Requested

  2. Length of Request

  3. Pay Status:

  4. Department:*

  5. Please note:

    The completed form must be submitted by both the employee and supervisor(s). The form must be submitted one week in advance. If approved by the Borough Manger, an approved email will be returned to the employees's supervisor.

  6. Leave This Blank:

  7. This field is not part of the form submission.