b. Personnel policy amended (FMLA)

SUflJECT; FAMILY MEDICAL LEAVE ACT (N) PAGE 2 5.G2 PAGr 7 OF 1~ You have not met the FMLA's 12-month length of service requirernent. As of the first date of requested leave, you will have worked approximately _ months towards this requirement . __ You have not met the FMLA's 1,250-hours-worked requirement. You do not work and/or report to a site with 50 ar move employees within 75 miles. If you have any questions, contact the Cass County Personnel. Office or view t!•ie FMLA poster located in the Cass County Fersonnel Office. [PART H-RIGHTS AND RESPQNSIHILITIES FOR TAKING FMLA LEAVE) As explained in Past A, you meet the eligibility requirements for taking FMLA )..Pave and sti.7.t have FM1,,A .Leave ava.labl.e in r.he applacabl.e 77 montY; period. However, in order for us to determine whether your absence qualifies as FMLA leave, you moat return. the following information to us by iIf a certification is requested, employers must allow at least 15 calendar days from receipt of this notice; additional time may be required in some circumsta:nces.) If sufficient. information is not provided in a timely manner, your leave may be denied. Sufficient certification to support your request for FMLA leave. A certification form that sets forth tkte information necessary tc> support your request is/ is not. enclosed... Sufficient documentation to establis'ti the .required relationship between you and your family member. Other information needed: No additional. information requested. If your leave does qualify as FMLA leave, you will have the following responsibilities while orx FMLA leave (only checked blanks apply): Contact the Cass County Personnel Office to make az•rangements to continue to make your share of the premium payments on your health insurance Co maintain health. benefits while you are on leave. Yotr have until the 20`" of each month to make premium pa~,!ments. If payment is not made timely, your group health. insurance may e cancelled, provided we notify you in wz~iting at: least 15 days before the date that. youz: Yaealth coverage will. lapse.