Este formulario debe ser completado por un empleado durante una consulta periódica por parte del empleador sobre si un empleado con Licencia FMLA tiene la intención de regresar a
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés.
For your convenience, the complete English version of this form is attached below the Spanish version.
Yes, you are entitled to maintain your health benefits under the same terms and conditions as if you were still working.
Yes, your employer can deny the leave if you're not eligible or if you don't follow proper procedures, like not providing enough notice.
You should notify your employer as soon as possible, ideally 30 days in advance if it's foreseeable, and provide them with necessary documentation to support your request.
Qualifying reasons include a serious health condition, the birth of a child, adopting a child, or caring for a sick family member.
You can take up to 12 weeks of unpaid leave in a 12-month period for qualifying reasons.
To be eligible, you need to work for a covered employer, have worked for at least 1,250 hours in the past year, and have worked at the company for at least 12 months.
The FMLA leave is the Family and Medical Leave Act that allows eligible employees to take unpaid leave for certain family and medical reasons without losing their job.
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Newark New Jersey Informe de estado periódico de licencia FMLA