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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.
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.
You do not have to tell your employer your diagnosis, but you do need to provide information indicating that your leave is due to an FMLA-protected condition (for example, stating that you have been to the doctor and have been given antibiotics and told to stay home for four days).
Under the Family and Medical Leave Act, employees cannot be fired simply because they are on leave. However, if there is another reason separate from medical leave, an employer does have the right to terminate an employee.
This memo is to notify you of my need for intermittent leave under the Family and Medical Leave Act. I require intermittent leave from [Start Date] to [End Date] . because of: temporary absences due to my own serious health condition.