Essay on Project Management

961 Words Oct 10th, 2015 4 Pages
Family and Medical Leave Request
The purpose of this document is to provide information for employees to request family and medical leave. The document includes: Page 1 - Employee Instructions - how to request family and medical leave
Page 2 & 3 - Family and Medical Leave Request form

Additional information regarding family and medical leave is available on WINHR on the Life & Disability page in the Review
Your Benefits section.

Employee Instructions:
1.

Review the following Family and Medical Leave (FMLA) information on WINHR. Go to the HR Central page and click the Policies link under the Policies section.
a.
b.

FMLA - Employee Rights and Responsibilities

c.

2.

FMLA - Employee Rights and Obligations Under Nissan's Policies

FMLA -
…show more content…
You can contact the Service Center by calling 1-866-599-4647 or using the AskHR feature on WINHR.

FMLA Request Form
COMPLETE FOR EACH ABSENCE AND SUBMIT BY CLICKING "Submit to HR Service Center" AT THE BOTTOM.

EMPLOYEE'S REQUEST FOR FAMILY MEDICAL LEAVE
ELIGIBILITY:

You must have at least 12 months of service with Nissan, have worked at least 1,250 hours during the 12 months preceding the leave, and have a qualified absence as noted below.

Employee Name:
Hire Date:

NNA

Employee ID:
Department:

NMAC

Manager:

TIME OFF:
You must select one from the section below. In addition, you must fill out the accompanying dates or date and times.

Full Consecutive Days Off (Off Full Shift)
Start Date:
End Date:
Intermittent Days
Date:
Start Time:
End Time:

QUALIFIED ABSENCE:
You must select one from the section below. If you select that you are caring for an ill or injured family member, you must choose the relationship and date of birth if that relationship is a child.

I have a serious health condition as defined below.
I am requesting time off to care for an ill or injured family member who has a serious health condition as defined below.
Spouse

Parent

Child (include birth date)

Birth Date:

I am taking time off to care for a new child in the home (include birth date above).
A serious health condition is any illness, injury, impairment, or physical/mental condition that involves (1) any inpatient
(overnight) hospital care, (2) more than 3 consecutive calendar

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