Notice of Eligibility and Rights & Responsibilities
Note: Effective January 1, 2014, all FMLA paperwork as well as decisions regarding an employee’s eligibility for FMLA leave will be administered by the FMLA Coordinator. The FMLA Coordinator can be reached at firstname.lastname@example.org or 612-673-5460 and will provide the employee with the necessary forms.
Before a qualifying leave is designated as FMLA, the FMLA Coordinator will determine if the employee is eligible to take FMLA leave. Once this determination is made, the FMLA Coordinator will notify the employee of their rights and responsibilities under the FMLA. This is done by giving the employee a Notice of Eligibility and Rights & Responsibilities.
The FMLA Coordinator will notify employees in writing of eligibility or non-eligibility within five (5) business days (absent extenuating circumstances) and thereafter during the same FMLA leave year, only if the employee’s eligibility status changes.
The eligibility notice must state:
1. Whether or not the employee is eligible; and
2. If not eligible, at least one reason why the employee is not eligible (i.e. does not have one (1) year of service and how much service the employee approximately has, does not meet 1044 hours requirement)
- Provide the employee with a completed, Notice of Eligibility and Rights & Responsibility Form. The appropriate Certification of Health Care Provider Form should be attached.
- If a fitness for duty is required for the employee to return to work, the FMLA Coordinator must attach the essential job functions/job specifications to the appropriate certification form.
- If the employee has exhausted their 12-week FMLA entitlement in the preceding 12 months, the request will be denied.
Last updated Jul 28, 2016