Student Name:  

Instructor:  

Program: ProgramClinical Medical AssistantPharmacy TechnicianPhlebotomy TechnicianMedical Administrative Assistant (MAA)MAA with Business AdministrationMAA with Billing & CodingMAA with Electronic Health RecordsMAA with EHR and B&CBilling and CodingElectronic Health RecordsEKG TechnicianEKG & Phlebotomy TechnicianMedical Mental Health TechnicianDental AssistantPersonal TrainerHelp Desk IT Support TechnicianInformation Technology ManagerInformation Technology SpecialistCyber Operations SpecialistMicrosoft 365: Modern Desktop AdministratorCisco Certified Network AssociateCisco Certified Networking Professional - EnterpriseCisco Network EngineerCompTIA A+CompTIA Network+CompTIA Security+Cyber Security ProfessionalInformation Security ProfessionalCertified Information Systems Security Professional (CISSP)CompTIA CASP+Business Administration (BA)Administrative AssistantBookkeeping and Payroll AssistantHuman Resources AssistantLegal Office AssistantSocial Media StrategistCertified Associate in Project ManagementProject Management ProfessionalCertified Lean Six Sigma Yellow BeltCertified Lean Six Sigma Green BeltCertified Lean Six Sigma Black BeltCertified Logistics Associate (CLA)Certified Logistics Technician (CLT)

Start Date: Dated  

Maximum Return Date (This date must be 6 months from the date of signing this LOA):

By digital signing this document you are agreeing to and understand the MedCertify Leave of Absence rules and regulations that have been laid out in the MedCertify Catalog. After submission this document will be sent to the proper channels for approval. Your MedCertify representative will reach out once approved. Please email us at [email protected] if more guidance is needed. 

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Change fonts

• Draw Signature
  
• Type In Signature
  

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

Insert Signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Signature Certificate

Document name: Leave of Absence

Unique Document ID: 143dda9f58740e4314bf21a704293a65095601b7

Build. Track. Sign Contracts.

Timestamp	Audit
February 8, 2022 3:49 PM EDT	Leave of Absence Uploaded by MedCertify Education - [email protected] IP 35.134.226.248
February 15, 2022 2:00 PM EDT	MedCertify Edu - [email protected] added by MedCertify Education - [email protected] as a CC'd Recipient Ip: 99.190.9.234
January 20, 2023 2:23 PM EDT	MedCertify Edu - [email protected] added by MedCertify Education - [email protected] as a CC'd Recipient Ip: 35.134.226.248

This audit trail report provides a detailed record of the online activity and events recorded for this document.

https://medcertify.com/

Audit Trail Serial# 67f1d6cf6944b0c134739a1282a3b0c0