409.3E2 Licensed Employee Family and Medical Leave Request Form

Code No. 409.3E1

CLASSIFIED EMPLOYEE FAMILY AND MEDICAL LEAVE NOTICE TO EMPLOYEES

This document is available at http://www.dol.gov/whd/forms/WH-381.pdf.

NOTE: FMLA section 109 (29 U.S.C. § 2619) requires FMLA covered employers to post the text of this notice. Regulations 29 C.F.R. § 825.300(a) may require additional disclosures.

Approved  9/23/2015

Reviewed 1/25/2023

Grinnell-Newburg School District, Grinnell, IA