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Members may download one copy of our sample forms and templates for your personal use within your organization. Please note that all such forms and policies should be reviewed by your legal counsel for compliance with applicable law, and should be modified to suit your organization’s culture, industry, and practices. Neither members nor non-members may reproduce such samples in any other way (e.g., to republish in a book or use for a commercial purpose) without SHRM’s permission. To request permission for specific items, click on the “reuse permissions” button on the page where you find the item.
Employee name: __________________________________________
Immediate supervisor: ______________________________________
On ___________________________, you requested FMLA leave. At that time we discussed with you that you were considered a key employee as defined by the FMLA. (The FMLA defines a key employee as salaried FMLA-eligible employee who is among the highest paid 10 percent of all the employees employed by the employer within 75 miles of the employee's worksite. The law gives an employer the option of declining reinstatement to an employee because of his/her status as a key employee if such reinstatement would cause the employer substantial and grievous economic injury to its operations.)
This notice is to inform you that after careful review, we have determined that reinstating you would indeed result in substantial and grievous economic injury to our operations.
Please contact me when convenient to discuss other options that may be available.
HR Director Date
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