By submitting this form, I hereby certify that the information given above is true and correct to the best of my knowledge. I understand that misrepresentation or omission of the reason for leave or ...

Employees should contact department personnel if they do not agree with their leave balances. Departments must retain a copy of employees' annual leave usage. Departments should provide copies for ...

You may fax completed forms to 1-866-751-5174 or mail them to: Standard Insurance Co. Employee Benefits Division P.O. Box 3877 Portland, OR 97208. 4. For a medical leave, be sure to also sign the ...