FMLA Inquiry Form - AFA Envoy
In order to help us gather information on current FMLA practices and to ensure the company’s new procedures conform with regulations and our collective bargaining agreement, please provide the following information if you have had any issues using FMLA.
First Name *
Your answer
Last Name *
Your answer
Employee Number *
Your answer
Base *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Date of Call *
MM
/
DD
/
YYYY
Time of Call *
Time
:
Company Representative Name
Your answer
Brief Description of the Issue *
Your answer
What information did you give them (that you feel comfortable sharing)?
Your answer
Was your request to code the absence as FMLA (paid or otherwise) approved?
If not, what reason was given?
Your answer
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