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Family/Medical Leave Healthcare Provider Certification Form NOTE: The information sought on this form pertains only to the condition for which the employee is requesting leave under FMLA. Employee.

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Related content

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The Family and Medical Leave Act (FMLA) provides certain employees with up to 12 weeks of unpaid, job-protected leave per year. It also requires that their group health benefits be maintained during the leave.

Key Employees and Their Rights. Under certain circumstances, an employer may deny job restoration to "key employees." A "key employee" is a salaried, FMLA-eligible employee who is among the highest paid 10 percent of all the employees employed by the employer within 75 miles of the employee's worksite.

Employee has at least 1000 hours of work and paid leave for employer in the preceding 52 weeks and employee worked for employer for at least 52 consecutive weeks. 12 weeks during a 12 month period. Leave for birth, adoption, or to care for sick parent or childmust be shared by spouses working for same employer.

Employees must make reasonable efforts to schedule leave for planned medical treatment so as not to unduly disrupt the employer's operations. Leave due to qualifying exigencies may also be taken on an intermittent basis. Employees may choose or employers may require use of accrued paid leave while taking FMLA leave.

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.

Intermittent FMLA is when an employee uses their 12 weeks of unpaid leave off and on. This is in contrast to continuous family medical leave or working a reduced work schedule. However, an employer may require that any accrued vacation or personal leave is used prior to taking the leave.

To request FMLA, you must complete an Employee Request for Family and Medical Leave (Online) 30 to 45 days days prior to the date you need your leave to begin. If you are unable to complete your request at least 30 days prior, then please submit it as soon as is practicable.

When employees exhaust twelve weeks of FMLA leave and still cannot return to work due to their own medical impairment, the employer may have an obligation under the ADA to grant additional unpaid leave as a reasonable accommodation, in some situations.

FMLA leave is unpaid, but employees may be allowed (or required) to use their accrued paid leave during FMLA leave. When an employee's FMLA leave ends, the employee is entitled to be reinstated to the same or an equivalent position, with a few exceptions.

Only employees who meet certain FMLA eligibility requirements are able to take this leave. If an employee isn't eligible for FMLA leave, the employee could still ask for a leave of absence, but that would likely be subject to approval by their manager, HR, and/or senior leadership and the interactive process.

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© Copyright 1997-2025
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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