
Occur. #
| Hire Date: | mm/dd/yyyy | |
| Hours Worked: | hhhh : mm | |
| Remaining FMLA Hours: | hhh | |
| Undesignated: | hh : mm |
| Has worked 12 months? | ||
|---|---|---|
| Hire Date: | mm/dd/yyyy | |
| Years Employeed: | # | |
| Has worked 1250 hours? | ||
| Hours Worked: | hhhh : mm | |
| Has available FMLA hours? | ||
| FMLA Used: | hhh : mm/480 | |
Request 020 Notes
[Login Name] on [date/time]: May have 2 episodes per month lasting 1 day per episode. May have 2 episodes per month lasting 1 day per episode.
Request 019 Notes
[Login Name] on [date/time]: [Populate submitted notes here.]
Request 019 Notes
[Login Name] on [date/time]: [Populate submitted notes here.]