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.
Alaska Employee Application for FMLA
State:
Multi-State
Control #:
US-AHI-200
Format:
Word;
Rich Text
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FAQ
The Alaska Family Leave Act (AFLA) provides a job-protected absence for up to 18 weeks in a 24-month period to eligible employees for a qualifying serious medical condition. It also provides a job-protected absence for up to 18 weeks in a 12-month period to eligible employees for pregnancy, childbirth or adoption.
FMLA leave is unpaid leave. However, workers may choose to, or employers may require them to, substitute accrued paid sick, vacation, or personal time for FMLA leave. Substitute means that the paid leave provided by the employer will run concurrently with the unpaid FMLA leave.
A leave of absence is typically an employer-approved period when the employee is excused from work duties. Each company often has a specific policy to cover this, such as two weeks unpaid time off. FMLA requires companies to provide employees unpaid time off if employees and employers meet specific qualifications.
In order to be eligible to take leave under the FMLA, an employee must (1) work for a covered employer, (2) work 1,250 hours during the 12 months prior to the start of leave, (3) work at a location where 50 or more employees work at that location or within 75 miles of it, and (4) have worked for the employer for 12
THE FAMILY AND MEDICAL LEAVE ACT (FMLA) requires covered employers to provide up to 12 weeks in a 12 month period of paid or unpaid, job-protected leave to eligible employees for qualifying family and medical reasons (the State of Alaska is a covered employer).
Leave and Reinstatement Rights Employees are entitled to continue their health insurance while on leave, at the same cost they must pay while working. FMLA leave is unpaid.
