The purpose of this notice is to inform you that Allegis Group is offering you the opportunity to receive electronic notices and forms related to your request for leave. If you do not have access to a computer through your normal work functions, you must consent to receive leave notices and forms electronically by signing the form below for us to provide you with this opportunity.

Prior to consenting, you should understand the following:

• You have the right to withdraw your consent to electronic distribution at any time at no charge to you. To withdraw consent, you must notify the Leave Services Team at Leave_Disability@allegisgroup.com. If you consent to electronic distribution, you may still request a paper version of any document free of charge by contacting the Leave Services Team at Leave_Disability@allegisgroup.com. or (866) 886-9798.
• To withdraw your consent or update your email address, please notify the Leave Services Team at Leave_Disability@allegisgroup.com. or (866) 886-9798.

I consent to the electronic disclosure of all leave notices and forms, including: DOL Notice of Rights and Responsibilities, DOL Certification of Health Care Provider Form, DOL Designation Notice, Parental Leave Week Request Form (PAL), Primary Caregiver Leave Request Form (PCG), Certification of Health Care Provider for Pregnancy Disability Leave Only (PDL), Health Care Provider Medical Certification (STD Form-Internal), Reminder Notice, Process Checklist, Additional Information letters, Intermittent Leave letters, State Disability letters, Contractor Enrolled STD notice, the 15-day Return to Work Reminder Letter, and any other regulatory or company leave document.

By clicking “Yes” on the previous screen, I acknowledge that I have read and understood that I am entitled to withdraw my consent at any time at no cost to myself. I understand that I have the right to receive all paper copies of leave notices and forms, upon request, at no additional charge. I also confirm that I have the ability and the necessary equipment and software to access and view the documents provided.