Arizona Application for Family Medical Leave of Absence

State:
Multi-State
Control #:
US-425EM
Format:
Word; 
Rich Text
Instant download

Description

This form may be used by an employee to request leave under the FMLA.
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How to fill out Application For Family Medical Leave Of Absence?

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FAQ

In Arizona, a leave of absence under the FMLA qualifies for reasons such as personal medical conditions, caring for a sick family member, or childbirth. Additionally, situations like adoption or foster care placement also qualify. Understanding the details of your Arizona Application for Family Medical Leave of Absence will clarify your eligibility and help you gather the required information.

To be eligible for FMLA benefits, you must:Work for an employer to whom the FMLA applies.Have been employed by the employer for at least 12 months (one year)Have worked for at least 1,250 hours during the 12-month period right before the start of the leave.More items...

You can get up to 12 weeks of job-protected leave with continuous health insurance coverage. For the first two weeks, the employee will not receive pay, but for the remaining 10 weeks, the employee can receive pay at a rate of two-thirds the employee's regular rate of pay. Pay is capped at $200 per day, or $10,000.

To be eligible for FMLA benefits, you must:Work for an employer to whom the FMLA applies.Have been employed by the employer for at least 12 months (one year)Have worked for at least 1,250 hours during the 12-month period right before the start of the leave.More items...

You worked at least 1,250 hours (about 25 hours per week) in the past twelve months. The FMLA allows an employee to take up to 12 weeks of unpaid leave in an FMLA year. The FMLA year may be the same as the calendar year, but does not have to be. The employer determines the FMLA year.

FMLA time off is unpaid. However, if the employer offers some paid time off, such as vacation pay, employers can require employees on FMLA to use this paid time off while on FMLA.

FMLA leave is available to Arizona employees who need time off to: recuperate from a serious health condition. care for a family member with a serious health condition. bond with a new child.

Your request for a leave of absenceDuring the first paragraph of your letter, state your request for a leave of absence. This is where you include the start date of your absence and the approximate return date. You can include your reason for a leave of absence with as much detail as you feel comfortable with.

Sample LetterI am writing to inform you that I will be taking a sick leave because of a serious infection in my throat. I will be absent from work until October 14. I have attached a note from my doctor to confirm that it is necessary for my health and the health of my coworkers for me to take a medical leave.

Arizona families will face increased family and medical care needs. Paid leave means older adults and working people of all ages can get the support they need to receive and provide critical care.

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Arizona Application for Family Medical Leave of Absence