Get Family Medical Leave Application

While the FMLA only applies to employers who employ 50 or more employees within a 75 mile radius of the employee requesting leave, 29 C.F.R. 2611(4)(A), the FLA applies to employers with at least 30 employees even if some of those employees work out-of-state or more than 75 miles away from the requesting employee.

The NJFLA allows people to take 12 weeks off from work in 24 months, while the FMLA allows employees to take 12 weeks off from work in 12 months.

Begin by speaking with your employer about when you need to take leave. Try to provide at least 30 days notice before your official start date, if possible. Then, you can create an account on paidleave.mass.gov and apply online.

Unpaid, unless you have accrued leave credits (regardless of whether you qualify for short-term disability or Workers' Compensation benefits). As long as you return to work at or before the end of the allowed leave, you will return to your former position or one that is equivalent in terms of benefits, pay and status.

To apply for leave under FMLA, contact the personnel office of your employer agency. If eligible and approved, the personnel office will provide to the Fund's administrative office the appropriate information for continuation of Fund benefits.

Unlike the federal FMLA, there is no requirement in the HFLL that an employee work a minimum number of hours within the six-month period. Consecutive employment means continuous employment with no break in service, such as by resignation, termination or layoff.

Depending on individual circum- stances, FMLA & NJFLA can be used concurrently (if the individual qualifies for both at the same time) or consecutively. FMLA may be used for self-care followed by NJFLA for family care.

Applying for FMLA The employee's health care provider must complete a certification form that validates the employee's serious health condition or that of an immediate family member. The employee must provide this certification to the employer within 15 calendar days of receiving it.