Employee FMLA Policy

EMPLOYEE FMLA POLICY

Employee Information

Position Information

Policy Statement and Purpose

This policy describes employee rights and responsibilities under the Family and Medical Leave Act (FMLA). The Company provides job-protected leave and maintenance of group health benefits as required by law to eligible employees for qualifying family and medical reasons. This policy sets forth the procedures for requesting leave, required documentation, designation and certification processes, employee and employer obligations, and consequences of misuse or failure to comply.

Eligibility

To be eligible for FMLA leave an employee must have been employed for at least 12 months and have worked at least 1,250 hours in the 12 months prior to the leave. The employee must also work at a location where the Company employs 50 or more employees within 75 miles, or otherwise meet statutory eligibility requirements. Employees must notify Human Resources to initiate eligibility determination.

FMLA Leave Entitlements

Eligible employees are entitled to up to 12 workweeks of unpaid leave in a 12-month period for: the birth and care of a newborn child; placement of a child for adoption or foster care; to care for an immediate family member with a serious health condition; or the employee’s own serious health condition that renders the employee unable to perform essential job functions. Military family leave entitlements are provided as required by law, including up to 26 workweeks of leave to care for a covered servicemember.

Definitions

"Serious health condition" means an illness, injury, impairment, or physical or mental condition that involves inpatient care or continuing treatment by a health care provider as defined by statute. "Intermittent leave" is leave taken in separate blocks of time due to a single qualifying reason. The Company will follow statutory definitions when determining entitlement.

Requesting Leave and Notice Requirements

Employees must provide 30 days advance notice when the need for leave is foreseeable. When 30 days notice is not practicable, notice must be given as soon as practicable. The Company may require periodic updates during a leave and interim reports on intent to return to work.

Medical Certification, Recertification, and Fitness-for-Duty

The Company will require medical certification from a health care provider to support requests for leave for a serious health condition. Recertification may be required periodically. For return-to-work following a serious health condition, the Company may require a fitness-for-duty certification that specifically addresses the employee's ability to perform essential job functions.

Use of Paid Leave

Employees may be required to substitute accrued paid leave (sick, vacation, or paid time off) for unpaid FMLA leave in accordance with Company policy and applicable law. Accruals will continue to be governed by Company policies during leave as required by law.

Benefits and Job Restoration

During FMLA leave, the Company will maintain group health insurance coverage on the same terms as if the employee had continued to work. Upon return from FMLA leave, employees will be restored to their original position or to an equivalent position with equivalent pay, benefits and other terms and conditions of employment unless an exception under law applies.

Designation and Employer Notice

The Company will notify employees whether leave has been designated as FMLA-protected and the amount of leave counted against the employee's FMLA entitlement. Designation will follow receipt of sufficient information and required certification.

Confidentiality and Fraudulent Claims

Medical information submitted in support of FMLA leave will be kept confidential and maintained in separate medical files. Any falsification, misrepresentation, or misuse of FMLA leave may result in disciplinary action, up to and including termination of employment and repayment of benefits.

Authorization to Contact Prior Employers and Providers

By signing this acknowledgment, the employee authorizes the Company to contact prior employers, health care providers, or other relevant third parties as needed to verify employment history or obtain medical information necessary to determine FMLA eligibility or to verify the information provided. The Company will request only information relevant to the leave determination.

I authorize contact:

Employment History (Most Recent)

Education

Graduation Date:

Professional References

Relationship:

Relationship:

Relationship:

Legal Disclosures

At-Will Employment: Nothing in this policy is intended to alter the at-will employment relationship. Either the employee or the Company may terminate employment at any time for any lawful reason, with or without cause.

Equal Opportunity: The Company is an equal opportunity employer. Leave and accommodations will be administered without regard to race, color, religion, sex, national origin, disability, age, or other protected status.

Employee Certification and Authorization

I certify that the information provided on this form is true and complete to the best of my knowledge. I understand that providing false or misleading information in connection with a request for FMLA leave may subject me to disciplinary action up to and including termination. I authorize the Company to verify any employment or medical information provided, to request necessary documentation from health care providers, and to contact prior employers when relevant to leave determinations.

I certify the above:

Acknowledgment of Receipt

By signing below, I acknowledge that I have received, read, and understand the Company’s FMLA policy and that I may be required to comply with the procedures and documentation requirements described herein.

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