Lawson State Community College Family And Medical Leave Request (Family And Medical Leave Act Of 1993)

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Family & Medical Leave Act (FMLA) Procedures
Step 1: Notify HR and your immediate supervisor as soon possible after you realize
FMLA is needed.
Step 2: Receive FMLA documentation from HR
HR will provide employee with Fact Sheet #28, Request for Family/Medical Leave form,
Medical Certification Form, and a FMLA Leave Request Form.
Step 3: Request for FMLA Form
Complete the Request for Family/Medical Leave Form as soon as you become aware of an
absence that may qualify under FMLA. The original form must be submitted to your
supervisor and a copy to the HR Office. This form should be submitted at least 30 days
(when possible) before the leave is to begin.
Step 4: Determine Eligibility
You should receive a determination of eligibility from Human Resources within 2 business
days after the Request for Family/Medical Leave form has been submitted.
Note: You must be employed at least 12 months and have worked at least 1,250
hours during the previous 12 months.
Step 4: Medical Certification Form
After eligibility has been determined, take the Medical Certification Form to your attending
physician or health care provider and have them complete the certification portion. Be sure
you and your doctor sign and date the form. The certification form must be returned to HR
within 15 calendar days of receipt. Failure to provide the certification may result in denial
or and/or delay in taking leave.
Step 5: Lawson State Community College FMLA Leave Request Form
Complete the FMLA Leave Request form. Sign and date the leave request form and have
your immediate supervisor approve the leave. Forward the leave form to HR for
processing. This should be done prior to taking leave.

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