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Acknowledgement of Receipt of Domestic Violence Leave Policy

  1. ALL TOWN EMPLOYEES ARE REQUIRED TO ACKNOWLEDGE RECEIPT OF THE DOMESTIC VIOLENCE LEAVE POLICY.
    This policy was adopted pursuant to the Massachusetts Domestic Violence Leave Act, G.L. c. 149, §52E. This law describes the rights and eligibility for leave for victims of domestic violence and the responsibilities of employers including those related to notification requirements and confidentiality.
  2. YOUR INFORMATION
  3. ACKNOWLEDGEMENT OF RECEIPT OF DOMESTIC VIOLENCE LEAVE POLICY
  4. By typing your full name above you are acknowledging that you have received and read the Domestic Violence Leave Policy
  5. SUBMIT YOUR ACKNOWLEDGMENT AND RECEIPT
  6. Leave the box below checked and enter your desired email address to recieve a copy of your form submission:
  7. Leave This Blank:

  8. This field is not part of the form submission.