Employees: Submit this FMLA Eligibility Determination Request Form to the Department of Human Resources, Employee Relations Division, at least 30 days before the leave is to begin, when possible. When 30 days’ advance submission of this form is not possible, submit the request as soon as possible. A late submission of this form may delay your FMLA leave approval.
Supervisors: Please complete if you acquire knowledge that your employee’s absence may qualify for FMLA leave, and the employee is unable to complete the form due to his/her incapacity.
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