Section 2: Acknowledgment and Signature by Employee. I understand that I am only able to request PMLA for one of the following reasons listed below: • Physical or mental illness, injury, or health condition of the employee or his or her family member • Medical diagnosis, care, or treatment of the employee or employee’s family member • Preventative care of the employee or his or her family member • Closure of the employee’s primary workplace by order of a public official due to a public health emergency • The care of his or her child whose school or place of care has been closed by order of a public official due to a public health emergency • The employee’s or his or her family member’s exposure to a communicable disease that would jeopardize the health of others as determined by health authorities or a health care provider For domestic violence and sexual assault situations, employees may use PMLA for the following reasons: • Medical care or psychological or other counseling • Receiving services from a victim services organization • Relocation • Obtaining legal services • Participation in any civil or criminal proceedings related to or resulting from the domestic violence or sexual assault I agree and understand that I have accurately reflected the reason for my absence and understand the Company may request documentation to validate the reason for my absence. By signing this document, I also acknowledge that if requested, documentation must be provided in accordance with the customary notice procedure for requesting leave and that requested documentation shall be provided within three (3) days following the date(s) of leave. PMLA must be used in 1-hour increments of time and will not be considered time worked for the purposes of calculating overtime pay. I understand that any misrepresentation of my reason for my absence may result in discipline, up to and including termination. Please type name below.