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Periodic Report [NAME] Periodic Status Report: Para to the Family and Medical Leave Act (FMLA), the Company is periode iuris ending any changes in your stats and tot conclusion of your leave. Accordingly, please complete this form and on or before, led to mak to work at the retam it to the Explayer: LHD, Please check one of the bees below: SSN: Resan De I reaffirmy to resum to work on. I no longer intend to return on my scheduled retam date for the following herefore request a new return date of I do not inked to rework Employee Signature: