FMLA Violation Information

If you believe your FMLA rights were violated according to the MEC grievance #36-99-2-176-25, please complete the form. Your information will be vital in protecting FMLA rights.

First Name

Last Name

Employee ID

Personal Email

Date of Requested FMLA

Date of Denied, Non-Requested FMLA

Result

Counted as a Sick Occurrence

Written Warning Level One

Written Warning Level Two

Termination

Unsure/Excused

More information

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