Programa De Obra

Preliminary Notice of FMLA Eligibility
Attention Manager: You must notify an employee of his or her preliminary FMLA eligibility within five work days (required by law) of either (1) an employee’s request for an FMLA LOA; or (2) when you obtain knowledge that an employee’s absence may be for an FMLA-qualifying reason. If the employee is already out of work, please send this form to the employeevia overnight delivery.
Dear Maria Garcia______________________________________________
Employee Name
On Dec. 13, 2011__________, you informed us that you needed leave for the following reason:
___ Your own serious health condition;
___ The birth of a child, or placement of a child with you for adoption or foster care;
_X_ To care for your spouse, son, daughter, or parent due tohis/her serious health condition;
___ To care for your spouse, son, daughter, parent or nearest blood relative who is a “covered servicemember” with a serious injury or illness; or
___ Because of a qualifying exigency arising out of the fact that your spouse, son, daughter, or parent is on active duty or call to active duty status in support of a contingency operation as a member ofthe National Guard or Reserves.
Based on the information you have provided, you are approved preliminarily for a Leave of Absence under the Family and Medical Leave Act (FMLA). Please see the attached forms,
which you are required to complete in order for Sodexo to confirm your FMLA eligibility.
Note: If you are absent from work for more than three consecutive calendar days due to awork-related injury or illness, you will automatically be placed on an FMLA Leave of Absence — if you are otherwise eligible for FMLA leave.
You are not eligible for a Leave of Absence under the FMLA because (check all that apply):
__ You have not been employed with Sodexo for at least 12 months.
As of the date of your request, you have worked approximately ____ months toward this requirement.
__You have not completed at least 1,250 hours of service in the 12 months prior to this request.
As of the date of your request, you have worked approximately ______ hours toward this requirement.
__ You have already exhausted your FMLA leave for the 12-month rolling backward period.
__ You requested leave for a reason that does not qualify under the FMLA.
Sincerely,____________________________________________________________________________
Manager’s Signature Date
Please place a copy of this form in the employee’s personnel file.

Manager –
Complete this form. 1
Leave of Absence Request Packet—
FMLA Leave
Dear Employee:
In order to process your leave and to confirm your FMLA eligibility, you must complete the attached forms and return them within fifteen (15)calendar days. If you are approved for FMLA leave, the approved time will be counted against your annual (rolling backward) 12-week (or 26-week for care of a “covered servicemember”) FMLA entitlement. If you are also eligible for leave under your state’s leave law, you will be offered the best of both leaves. If you fail to complete and return all required forms by the date listed below, you may notbe approved for FMLA and/or state leave and your absence may be treated as an unauthorized absence from work.
Manager – Fill in the date to return form:
You must accurately complete all required forms and return them to your manager or HR representative no later than _______________________.
(Note to Manager/HR Representative: Employees must complete and return all required forms within 15calendar days. Write the due date in the shaded area above. To ensure that employees are provided the full 15 days, please count the 15-day timeframe beginning the day after you provide this packet to the employee.)
Employee Name: Maria Garcia___________________________________________________
Employee Unit Name and Number: _________________________________________________
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