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September 21, 2009 (Regular Meeting) <br />(Employee Signature <br />te) <br />CCHRD Form 9B (rev. 4/03;7/06) <br />Appendix C <br />Employee Rights and Responsibilities Under the <br />FAMILY AND MEDICAL LEAVE ACT <br />Basic Leave Entitlement <br />By: <br />(Witness Signature) <br />FMLA requires covered employers to provide up to 12 weeks of unpaid, job- <br />protected leave to eligible employees for the following reasons: <br />• For incapacity due to pregnancy, prenatal medical care or child birth; <br />• To care for the employee's child after birth, or placement for adoption or <br />foster care; <br />• To care for the employee's spouse, son or daughter, or parent, who has a <br />serious health condition; or <br />• For a serious health condition that makes the employee unable to perform <br />the employee's job. <br />Military Family Leave Entitlements <br />Eligible employees with a spouse, son, daughter, or parent on active duty or <br />call to active duty status in the National Guard or Reserves in support of a <br />contingency operation may use their 12-week leave entitlement to address <br />certain qualifying exigencies. Qualifying exigencies may include attending <br />certain military events, arranging for alternative childcare, addressing <br />certain financial and legal arrangements, attending certain counseling <br />sessions, and attending post-deployment reintegration briefings. <br />FMLA also includes a special leave entitlement that permits eligible <br />employees to take up to 26 weeks of leave to care for a covered servicemember <br />during a single 12-month period. A covered servicemember is a current member <br />of the Armed Forces, including a member of the National Guard or Reserves, <br />who has a serious injury or illness incurred in the line of duty on active <br />duty that may render the servicemember medically unfit to perform his or her <br />duties for which the servicemember is undergoing medical treatment, <br />recuperation, or therapy; or is in outpatient status; or is on the temporary <br />disability retired list. <br />Benefits and Protections <br />During FMLA leave, the employer must maintain the employee's health coverage <br />under any "group health plan" on the same terms as if the employee had <br />continued to work. Upon return from FMLA leave, most employees must be <br />restored to their original or equivalent positions with equivalent pay, <br />benefits, and other employment terms. <br />Use of FMLA leave cannot result in the loss of any employment benefit that <br />accrued prior to the start of an employee's leave. <br />Eligibility Requirements <br />Employees are eligible if they have worked for a covered employer for at <br />least one year, for 1,250 hours over the previous 12 months, and if at least <br />50 employees are employed by the employer within 75 miles. <br />Definition of Serious Health Condition <br />A serious health condition is an illness, injury, impairment, or physical or <br />mental condition that involves either an overnight stay in a medical care <br />facility, or continuing treatment by a health care provider for a condition <br />that either prevents the employee from performing the functions of the <br />employee's job, or prevents the qualified family member from participating in <br />school or other daily activities. <br />Subject to certain conditions, the continuing treatment requirement may be <br />met by a period of incapacity of more than 3 consecutive calendar days <br />combined with at least two visits to a health care provider or one visit and <br />Page 1617 <br />Cabarrus County, North Carolina <br />