Dues Exoneration Form
This form is used to request Dues Exoneration.
Name
*
First Name
Last Name
Email
*
DO NOT USE A @jetblue email
Employee ID
*
Type of leave
*
Please Select
Medical
STD
LTD
Maternity
Personal
R&R
Gateway Program
OJI
Other
Other type of leave.
Date the leave started
*
-
Month
-
Day
Year
Date
Date of return to work /Expected date
-
Month
-
Day
Year
Date
Are you still out on leave?
*
Please Select
Yes
No
Other
Additional Info:
Submit
Should be Empty: