Human Resources Business Rules and Regulations
Page 6 of 15
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FMLA - Military Family Leave - Med Certificate for Veteran Family Member - WH-385V
Form to be completed by an employee and then health care provider when the employee seeks military caregiver leave under the FMLA leave due to a serious injury or illness of a covered veteran; this certification must provide sufficient facts to support the request for leave.
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FMLA Agency Response Designation Notice - FMLA-HR-2b
Form to be completed by agency human resources department notifying employee of the disposition of the employee's request for family leave, medical leave or military family leave.
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FMLA Agency Response Eligibility Notice to Employee - FMLA-HR-2a
Form to be completed by agency human resources department notifying employee of his/her eligibility in response to employee's request for family leave, medical leave or military family leave.
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FMLA Caregiver Medical Certificate P-33B
Form to be used by employees seeking family leave to care for a spouse, child, or parent with a “serious health condition". Form must be completed by family member's attending medical provider.
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FMLA Employee Medical Certificate P-33A
Form to be used by employee who is absent for personal illness, including FMLA absences; form must be completed by employee's attending medical provider.
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FMLA Employee Request Form - FMLA-HR-1
Form to be completed by employee requesting family leave, medical leave or military family leave.
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FMLA Statement of Qualifying Family Relationship FMLA-HR4
For Family Leave or Military Family Leave
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Forms Approval Process - Comptroller Memorandum No. 2002-09 - March 28, 2002
Approval process for agencies to change forms to mirror Comptroller forms
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Grievance and Appeal to the Office of Labor Relations - PER-144
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The Appendix lists all state job classifications which have been designated as covered under the hazardous duty provisions of the State Employees Retirement System.
