b. Personnel policy amended (FMLA)

SUBJECT: FAMII:Y MEI)ICAI., LEAVE ACT (N} 5 . rJ 7. PAGE; 6 OF 19 In general, to be eligible, an employee must have worked for. an emplryer far at least 12 months, have worked. at least 1,s5U hours in the 12 months preceding the leave, acrd work at a site with at least 50 employees within 75 miles. While use of this farm by employers ire optional., a fully completed farm provides employees with thM information required by 29 C.f'.R. § 82~.300(b), which must be pzovide~i within five business days of the employee notifying the employer oi' the need Ear FMIaA leave. Part B provides employees with informatar: rsgardirrg their rights and responsibilities far taking FMLA Ieave, a~ requir~rd by 7.~ C.F.R. § 8?.5.300 (b} , (c} . [PART A - NOTICE; OF ELIGIHILITXj TL} Employee FROM: I?AT E : Employer Representative On beginning an Notice of Eligibi:tity and Rights & Respansibil.ties (Family and Medical T,eave Act} you informed us that you needed leav<.- for: The birth of a child, ar plac:ement of a child with you. fox adoption or foster care; Your awn serious health condition; Because you are needed to care for your spouse; child; parent due to his/her serious health condition Because of qualifying exigent}r arising out of the fact that your- ....:..............spouse; son or daughter; parent is an active duty. or ca1.:Ied to active duty status in support of a contingency operation as a member of tYie National Guard ar ReseYVes. Because you are the spouse; son or daughter.; parent; next of kin of a covered servitemember with a serious irzjux-y a. illness. This notice is to inform you that you: Are el igil~le for FMT.A leave (See Part B below for Rights and. Responsibilities) Are not eligible far FMT.,A leave, because (only one reason Head ka~. clreckeci, although you may not be eligilsle far ether reasons}