Instructions for Certification - Lower Tier Participants (Applicable to all subcontracts, purchase orders and other lower tier transactions requiring prior FHWA approval or estimated to cost $25,000 or more - 2 CFR Parts 180 and 1200)
Medical Certificates (a) An employee who has given the Employer notice of their intention to take paid or unpaid parental leave, or unpaid partner leave shall provide the Employer with a medical certificate from a registered medical practitioner naming the employee, or the employee’s partner, confirming the pregnancy and estimated date of birth.
CERTIFICATE OF SERVICE I certify that I served a true and correct copy of the foregoing Consent Agreement and Final Order, docket number FIFRA-05-2021-0016 , which was filed on May 26, 2021 , in the following manner to the following addressees: Copy by E-mail to Xx. Xxxxx X. O’Meara Attorney for Complainant: xxxxxx.xxxxx@xxx.xxx Copy by E-mail to Xx. Xxxxxx Xxxxxxxxxxx Respondent: xxxxxxxxxxxx@xxxxxxx.xxx Copy by E-mail to Xx. Xxx Xxxxx Regional Judicial Officer: xxxxx.xxx@xxx.xxx Dated: XXXXXX XXXXXXXXX Digitally signed by XXXXXX XXXXXXXXX Date: 2021.05.26 09:08:15 -05'00' XxXxxx Xxxxxxxxx Regional Hearing Clerk
Medical Certificate 🞏 Absent from Work (first date of absence) 🞏 Not absent from work but requires accommodations Part 1 – Employee - please complete following: (Employee Name) The information supplied will be used in a confidential manner and may assist in creating a return to work plan. I hereby consent to the completion of this form by: (Treating Medical Practitioner’s Name) (Signature of Employee) (Date)