AGENCY: Division of Human Resource Management

SERIES: 25720
TITLE: Family Medical Leave applications
DATES: 1993-2006.
ARRANGEMENT: Alphabetical by name

DESCRIPTION: This record contains applications for an employee to take leave based on the Family and Medical Leave Act (FMLA) of 1993. The FMLA application contains the employee name and address, start date of anticipated leave, expected date of return, reason for leave and employees signature. Additional information contained in this record may include payroll information, employee occupation, rate or basis of pay in terms of compensation, daily and weekly hours worked per pay period, additions to or deductions from wages, total compensation paid, dates leave is taken by employee, information regarding employee benefits or employer leave policies, premium payments of employee benefits, response to employee FMLA request; return from leave form; and data regarding any dispute between employer and an employee over the designation of leave as FMLA leave.

RETENTION

Retain for 3 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series is authorized by Archives general schedule Employee health and medical records, GRS-1968

AUTHORIZED: 02/18/2005

FORMAT MANAGEMENT

Paper: Retain in Office for 3 years and then destroy.

APPRAISAL

Administrative

PRIMARY DESIGNATION

Private. UCA 63G-2-302 (2008)

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