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DOL CERT QUALIFYING EXIGENCY.PDF
FMLA CERT OF QUALIFYING EXIGENCY FOR MILITARY FAMILY LEAVE

UPDATED BY FEDS EFFECTIVE 01.01.2012 - TO BE USED WHEN AN EMPLOYEE REQUIRES A LEAVE OF ABSENCE FOR QUALIFYING EXIGENCY MILITARY DEPENDENTS

Handle: Document-19354
Owner: Hanson, Jean (User-867, 07736:EVERETT)DS
Thursday, January 22, 2009 08:53:36 AM PST
Wednesday, September 27, 2023 02:15:29 PM PDT
Modified By: Mulvaney, Linnea (User-5348, 14156:EVERETT)DS
Locked By:
  • Certification of Qualifying Exigency
For Military Family Leave(Family and Medical Leave Act) U.S.
  • Department of Labor
Wage and Hour Division OMB Control Number: 1235-0003Expires: 2/28/2015SECTION I: For Completion by the EMPLOYERINSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employermay require an employee seeking FMLA leave due to a qualifying exigency to submit a certification.
  • Be as specific as you can; terms such as “unknown,” or “indeterminate” may not be
sufficient to determine FMLA coverage.
  • ___ Other documentation from the military certifying that the covered military member is
on active duty (or has been notified ...
Allowed
Adobe Portable Document Format (.pdf) - application/pdf
FMLA Form - Qualifying Exigency - WH-384.pdf
No
4
314178
No
Appears In: LEAVE OF ABSENCE INFORMATION
Preferred Version: DOL CERT QUALIFYING EXIGENCY.PDF