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(Date)

Employee Name

Address

Dear (Employee):

This letter is to inform you your employment has been separated effective ___________________. Your separation is based solely on the exhaustion of the available 12 weeks Family Medical Leave, which started on _________________. Unfortunately, we can no longer hold your position. However, you are eligible for rehire, and you are welcome to apply for other positions within the organization.

Please see the attached clearance forms for you to officially clear from the health system. Please do not hesitate to call me if I can ever be of assistance.

You have the right to file a discharge dispute within five business days of your receipt of this notice with the Vice President for Human Resources, or her designee. Please contact Sandy Huntington, HR Records Supervisor, at 721-1016 to make arrangement for your clearance.

We appreciate your contributions to (Department) and wish you every success in the future.

Sincerely,

(manager)

• CC: Human Resources

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