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.
Fmla Form Filled Out Example
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
Your employer cannot retaliate against you for taking FMLA leave, such as by withholding promotions or raises, or firing or disciplining you. Your employer must allow you to use paid time off in tandem with your FMLA leave to continue getting paid, if you have paid leave accrued.
Autism, many chronic or long-term physical illnesses, and many psychiatric and developmental disabilities fall within the law's coverage.
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.
Can you give a 2-week notice while on FMLA? If you are on FMLA leave, you may notify your employer that you are leaving the company in 2 weeks.
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.