Notice: While unemployment insurance payments have not been impacted by the federal government shutdown at this time, November benefits for FoodShare members have been reduced due to the ongoing shutdown. For questions about using FoodShare benefits, information about benefit delays, or help finding food assistance resources, visit:
Wisconsin Department of Health Services' FoodShare webpage
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Document Number: ERD-10111-E
Description: This form should be used by employers to assist in establishing leave entitlement under Wisconsin's Family and Medical Leave Law.
Comments: This form may be reproduced by employers.
Content Contact: Equal Rights Information
Document Attachments:
ERD-10111-E (English Electronic Version - Word/68 KB)
ERD-10111 (English Print Version - pdf/18 KB)
ERD-10111-S (Spanish Print Version - pdf/82 KB)
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.
DWD Contact Information
201 E. Washington Ave
P.O. Box 7946
Madison, WI 53707
(608) 266-3131
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