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 With Time
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
Can I take a long leave of absence from work? ing to the FMLA, you can avail up to 12 weeks of unpaid leave of absence during a period of 12 months if you are eligible. Some non-FMLA medical leave may still be covered under ADAAA.
Dear (Supervisor / HR Manager): 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.
An employee must have been employed for at least 1,250 hours of service during the 12-month period immediately preceding the commencement of the leave. The hours of service are counted for the 12-month period immediately preceding the leave and generally must be actual hours worked by the employee.
Do I have to return to work to quit? FMLA does not require that you must return to your employment at the end of your leave of absence, or provide two weeks notice of not returning to the company. Unfortunately, you may be immediately terminated if you provide two weeks notice.
The Family and Medical Leave Act (FMLA) provides eligible employees up to 12 workweeks of unpaid leave a year, and requires group health benefits to be maintained during the leave as if employees continued to work instead of taking leave.