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Were you:

(1) employed by the employer for at least 12 months, and

(2) been employed for at least 1,250 hours of service during the 12-month period immediately preceding the commencement of the leave, and

(3) employed at a work site where 50 or more employees are employed by the employer within 75 miles of that work site.

Yes

No

FMLA CASE SCREENER