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Michigan County Road Commission Self-insurance Pool
(800) 842-4971
417 Seymour Ave., Suite 2, Lansing, MI 48933
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Media Category: Chapter 12: Family and Medical Leave Act

Certification for Serious Injury or Illness of a Veteran

Certification for Serious Injury or Illness of Covered Servicemember

Certification of Qualifying Exigency

Designation Notice

Notice of Eligibility and Rights & Responsibilities

Certification of Health Care Provider for Family Member’s Serious Health Condition

Certification of Health Care Provider for Employee’s Serious Health Condition

Notice of Intention to Return from Leave

Response to Application for Family or Medical Leave

Application for Family or Medical Leave

Michigan County Road Commission Self-Insurance Pool

(800) 842-4971

417 Seymour Ave., Suite 2, Lansing, MI 48933

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