ࡱ> 241 bjbjVV .<< 89}MMMMM$'!#""MM47LMMxM00&FpM0},o$o$"o$4<""L}o$ : Sample Letter 9 Employee Not FML Eligible (For Requests for PDL Only) [Date] [Employee Name] [Employee Address] Dear [Employee Name]: In response to your request for leave of absence due to a disability resulting from your pregnancy, childbirth, or related medical condition, we are providing you with information pertaining to the Universitys Leave of Absence policy and the Family and Medical Leave (FML) policy. This is to inform you that you are not eligible for FML for the reasons set forth in the enclosed Notice of Eligibility and Rights & Responsibilities. However, you are entitled to up to 4 months of Pregnancy Disability Leave. Enclosed are several forms: Leave of Absence Request Notice of Eligibility and Rights & Responsibilities Certification of Health Care Provider for Employees Pregnancy Disability Please read these documents carefully. The Notice of Eligibility and Rights & Responsibilities sets forth the reasons you are ineligible for FML. Please complete the employee section of the Leave of Absence Request and have your health care provider complete the Certification of Health Care Provider for Employees Pregnancy Disability. The Leave of Absence Request and the Certification of Health Care Provider for Employees Pregnancy Disability should be returned to _______ within 15 calendar days of this request. If you have any questions about this, please let me know. Sincerely, [Name] Cc: Benefits [ER/LR/HR, as applicable] Enclosures: Leave of Absence Request Notice of Eligibility and Rights & Responsibilities Certification of Health Care Provider for Employees Pregnancy Disability     +-.1>@AFGHIJKLPQRSUVWdefgwźźř{n{f^VK{n{{nhhTB*phh<B*phhTB*phhB*phhh6B*phhh"]^B*phhh<B*phhB*phhhB*phh/5B*\phh5B*\phhO5B*\phhT5B*\phhhT5B*\phhD j5B*\phh<5B*\phh25B*\ph,HIJRSTUVfy{ F G R S @&gd; & FgdTgdT$a$gdT $@&a$gd;wx 1 2 C S i j F H P Q ] ! ( 0 2 3 < D P R S ǺԲ鲪ԲԲԲԲԲhhB*phhdEB*phh>fB*phhOB*phh2B*phhB*phhB*phhh5B*phhh5B*phhTB*phhh6B*phhhB*phhh"]^B*ph2 A ^`gdTgdT ./@Aº­ɕ}rjfjfjfjfrh Gjh GUhhB*phhB*phh"]^B*phhydB*phhh"]^B*phhTh6B*phhThF:6B*phhx#hF:6 hmhF:hTB*phhhB*phhhTB*phhXh6B*phhF:h"]^B*ph ,1h/ =!"#$% ^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List HH 7 Balloon TextCJOJQJ^JaJ44 0Header  !4 4 0Footer  !ZY"Z ; Document Map-D M CJOJQJ^JaJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]  w    @  @H 0(  0(  B S  ?CK3HIJKKRT QYTh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH Q         bZ0[0[IHZyuSyd  %#P#Ce%*/n<5?67F:9<)D$EdEZGzGMOV Z"]^,iD jD|Lw~/Je2&*A<T Gzso-G{/2B 1eX;]xy i>f0 g4OK2.(#] DocStamp_1_DocIDDocStamp_1_IncludeDate DocStamp_1_IncludeDraftTextDocStamp_1_IncludeTime$DocStamp_1_InsertDateAsField0DocStamp_1_TypeIDؙMPDocIDMPDocIDTemplateDefault۫NewDocStampTypeؙC:\Documents and Settings\sleider\Application Data\Hummingbird\DM\Temp\OGCS06-#190858-v1-FML_Sample_Le__e__9_-_Employee_NOT_FML_Eligible_-_Fo__Reques_s_fo__PDL_O_ly_.DOCFalseFalseFalseFalse7190858.1:SLEIDER:SLEIDER%n|.%v|:%u|:%y7@h@UnknownG* Times New Roman5Symbol3. * Arial5. *aTahoma?= * Courier New;WingdingsACambria Math"1hJJ:ئ  !24d 3QHP ??6!xxFMLA LEAVE REQUEST COVER LETTERSLEIDERUniversity of California Oh+'0  0< \ h t  FMLA LEAVE REQUEST COVER LETTERSLEIDERNormalUniversity of California2Microsoft Office Word@@@d&@d&՜.+,0 hp|      FMLA LEAVE REQUEST COVER LETTER Title  "#$%&'(*+,-./03Root Entry F&51Table$WordDocument.SummaryInformation(!DocumentSummaryInformation8)CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q