ࡱ> 8:7 bjbjVV .<<s LL8,     ???.,0,0,0,0,0,0,$Y.0T,?????T,  4i,?L  (~?.,"&h^' &F&(,0,&11 ^'^'"1'???????T,T,L???,????1?????????L U:  Sample Letter 4 Employee FML Eligible (For Leave for Family Members Serious Health Condition) [Date] [Employee Name] [Employee Address] Dear [Employee Name]: In response to your request for a leave of absence to care for a family member with a serious health condition, we are providing you with information pertaining to the Universitys Family and Medical Leave (FML) policy. Enclosed are several forms: Leave of Absence Request Notice of Eligibility and Rights & Responsibilities Certification of Health Care Provider for Family Members Serious Health Condition Declaration of Relationship Part A of the Notice of Eligibility and Rights & Responsibilities states that you are eligible for FML. Part B provides information about whether you are able or required to substitute paid leave for unpaid leave and any responsibilities you may have while on leave. Please read this Notice carefully. Please complete the employee section of the Leave of Absence Request and Section II of the enclosed Certification. Also, please have your family members health care provider complete Section III of the Certification. All forms to be completed should be returned to _______ within 15 calendar days of this request. Failure to provide the required documentation may result in delay or denial of leave. If you have any questions, please let me know. Sincerely, [Name] Cc: Benefits [ER/LR/HR, as applicable] Enclosures: Leave of Absence Request Notice of Eligibility and Rights & Responsibilities Certification of Health Care Provider for Family Members Serious Health Condition Declaration of Relationship     "#*+,-1;deghlmopqr㥰wodwwwoYhVhVB*phhVhKB*phhhkB*phhVhhk6B*phhVh3:B*phhVhhkB*phhVhhkB*phhD[M5B*\phhVhhk5B*\phhKhV5B*^JphhV5B*\phhK5B*\phhVhV5B*\phhVB*OJQJ^Jph"+egnpq G c d , - \ ] ^gdV & FgdVgdV^gdV$a$gdV@&gde b + , G b d |  " 2 ~ + , - [ \ ] g h 鯫htB*phhD[MB*phhvjB*ph hVhVhhk hVhhkhV hVh3:hVh3:B*o(phhVB*phhVhVB*phhhkB*phhVh3B*phhVh3:B*phhVhhkB*ph2] h i p r 5Ssuvxy{|~gdVh i j n o r 7:qrstvwyz|}ԲhZ+jhZ+U hVh(#h+mB*phhQ@hxhQ@6 h }hQ@hVhhkB*phhVhhk6B*phhQ@h3B*phhVB*ph,1h/ =!"#$% ^ 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 JJ hkmsolistparagraphdd[$\$^^ hkmsolistparagraphcxspmiddledd[$\$ZZ hkmsolistparagraphcxsplastdd[$\$4"4 Header  !4 24 Footer  !ZYBZ e Document Map-D M CJOJQJ^JaJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$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$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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