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335. ATTACHMENT FMLA LEAVE REQUEST FORM EMPLOYEE REQUEST FOR FAMILY OR MEDICAL LEAVE EMPLOYEES NAME: DATE: ADDRESS: CITY ZIP REASON FOR TAKING LEAVE (CHECK ONE): 1. TO CARE FOR MY CHILD AFTER BIRTH.

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Most school employees who have been employed for at least 12 months are eligible for FMLA. Eligible employees may take up to 12 weeks of unpaid leave in a 12-month period for one of the following reasons: Birth of a child and to care for the newborn child within one year of birth.

Unfortunately, you are generally not able to collect unemployment while on FMLA leave. There are a couple of exceptions: You have restrictions but believe that you can work, and your company forces you to take leave anyway. You can work in other positions at the company, but your employer won't let you.

Your employer is not mandated to pay you while on leave under the FMLA. The FMLA only requires unpaid leave. Your employment arrangement may require you to use all accrued paid leave during your FMLA leave.

Employees are eligible for leave if they have worked for their employer at least 12 months, at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles.

Eligibility is determined based on two factors: One year of employment and 1,2501 hours worked during the 12 month period preceding the date of the first absence of each event. An event is a specific reason or medical condition for which an FMLA absence is approved.

Please be advised that I hereby request an FMLA leave for a period of (number of weeks) in connection with my serious health condition. The leave is to start on (date). Attached is my medical note reflecting the need for FMLA leave. Please let me know whether you approve this leave at your earliest convenience.

You do not have to tell your employer your diagnosis, but you do need to provide information indicating that your leave is due to an FMLA-protected condition (for example, stating that you have been to the doctor and have been given antibiotics and told to stay home for four days).

You are entitled to a maximum of 12 weeks per year of leave under the FMLA. Do I have to take all my leave at once? No. The FMLA permits you to take intermittent leave or to work a reduced schedule for planned medical treatment for a serious health condition.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232