Apprentice Leave Request
I am assigned out of
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Anchorage (Unit 101)
Fairbanks (Unit 102)
Juneau (Unit 103)
Ketchikan (Unit 104)
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
Classification
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Lineman
Telecommunications
Tree-trimmer
Wireman
Current Employment Status
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Employed
Unemployed
In class
Current Employer
*
Start Date
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-
Month
-
Day
Year
Date
End Date
*
-
Month
-
Day
Year
Date
Reason for request
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Is this medical leave?
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Yes
No
If this is medical leave, I understand I will be required to submit a Physician Appraisal Form in order to return to work
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Yes
Submit
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