This form is an application for Family and Medical Leave. It is to be filled out by an employee who is requesting a leave of absence.
Application Fmla Print For Employees
State:
Multi-State
Control #:
US-AHI-200
Format:
Word
Instant download
Description
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How to fill out Employee Application For FMLA?
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FAQ
FMLA Notification Letter. Dear EMPLOYEE, We have reviewed your request for leave under the FMLA and supporting documentation you have provided. This letter is intended solely as notice you are eligible for leave under the Family and Medical Leave Act of 1993 (FMLA).
Copies of employee notices of leave provided to the employer under the FMLA, if in writing, and copies of all eligibility notices given to employees as required under the FMLA (copies may be maintained in employee personnel files).
All covered employers are required to display and keep displayed a poster prepared by the U.S. Department of Labor summarizing the major provisions of the Family and Medical Leave Act (FMLA) and telling employees how to file a complaint.
The FMLA entitles eligible employees to take up to 12 weeks of unpaid, job-protected leave in a 12-month period for reasons specified in the FMLA. Under certain circumstances, families caring for service members recovering from a serious injury or illness may take up to 26 weeks of unpaid, job-protected leave.
I require a leave of absence from [Start Date] to [End Date] . because: I am temporarily unable to work because of my own serious health condition. I will be caring for a family member (spouse, child, or parent) with a serious health condition.