Page 18 - Employee Handbook January 2018

4.10 Family and Medical Leaves of Absence

Employees who qualify for a leave under the FMLA Act of 1993

The company will grant a leave of absence to regular full time and regular part time employees (who meet the require-
ments listed below) for the care of a covered family member (spouse, child, or parent) with a serious health condition, or
in the event of the employee’s own serious health condition. Leave will also be granted in the case of the birth or adop-
tion of a child. Leave will be granted up to twelve weeks in any twelve-month period.

Eligible employees for FMLA must have completed at least one full year of service with the company and have worked
a minimum of 1,250 hours in the twelve-month period preceding the leave to be eligible for it.

Application and Notice of Leave

Employees requesting leave must submit to Hercules an application for leave. The completed application must state the
reason for the leave and duration including starting and ending dates. Applications for this leave must be submitted in
writing to Human Resource Manager and Direct Supervisor at least thirty (30) days before the leave of absence is to
begin. If thirty (30) days notice by application is not practicable, the employee must notify his or her manager by any
means necessary as soon as possible, typically within one or two working days of learning of the need for leave.
If an employee is on paid or unpaid leave, disability leave or absent pursuant to worker’s compensation, and it should
come to Hercules’ attention that the absence qualifies as FMLA leave, Hercules may designate the leave as FMLA leave
and will so notify the employee.

Your rights under FMLA Act and certifications will be provided to you upon notification that a Leave of Absence has
been requested. FMLA forms must be submitted to Human Resources prior to an approved Leave of Absence. During
an employees Leave of Absence they may be responsible for medical/dental benefits that you are enrolled in. It is also
necessary for employees to discuss any accrued vacation/sick time that you may have remaining, as it will be necessary
for you to exhaust any accruals you may have during your absence.
Further detailed information regarding FMLA may be extended to you by contacting the Human Resources department.
Should you have further questions please contact the Human Resources department at 757-222-3747 or 757-473-3733.

Medical Certification
The employee must also obtain from Hercules its Medical Certification Form, have the form completed by a health care
provider and return it to Hercules. Failure to do so may delay the commencement of your FMLA leave, or FMLA leave
may be denied.

Medical Certification Forms covering the requested leave may be obtained from Human Resources. Hercules has the
right to obtain second or third opinions after receipt of the Medical Certification.

Military Leave of Absence

Hercules Living Employee Handbook March 2016 Page 18