California Leave of Absence Application Form

State:
Multi-State
Control #:
US-AHI-269
Format:
Word; 
Rich Text
Instant download

Description

This AHI form is to be filled by an employee who is requesting a leave regarding medical, family, military, or personal leave.

How to fill out Leave Of Absence Application Form?

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FAQ

If the claimant files a claim while on a "true" leave of absence, eligibility is based on the reason for the leave. If the claimant on a "true" leave of absence, quits the employment and then files a claim, eligibility is based on the reason the claimant quit the job.

When requesting a formal leave of absence, your letter should include:Request for a leave of absence,The dates you expect to be away from work,The date you plan to return to work,An offer to provide assistance, if feasible,Thanks for considering your request.

Employees may take unpaid time off to care for a seriously ill parent, spouse or child, for the employee's own serious health condition or to bond with an adopted or foster child or newborn.

If eligible, you can receive benefit payments for up to eight weeks. Payments are about 60 to 70 percent of your weekly wages earned 5 to 18 months before your claim start date. You will receive payments by debit card or check it's your choice! PFL provides benefit payments but not job protection.

Request a leave of absenceSubmit a Formal Leave of Absence Request (DGS OHR 28) form to their immediate supervisor for approval (provide substantiation when required or requested).Provide a reason and a beginning and end date of leave (not to exceed one year).More items...

Employees may take unpaid time off to care for a seriously ill parent, spouse or child, for the employee's own serious health condition or to bond with an adopted or foster child or newborn.

Some common reasons employees take a leave of absence are to recover from a serious illness, undergo a medical procedure, assist a family member, take an extended trip or welcome a new child into the family.

There are no lower limits for how long a worker may go on leave. As mentioned above, your leave of absence may be for as little as 2 hours (for voting leave), or as long as 26 weeks (for military family or spouse leave). However, you cannot take more than the allowed periods in any case.

If the claimant on a "true" leave of absence, quits the employment and then files a claim, eligibility is based on the reason the claimant quit the job. If the claimant is discharged while on a "true" leave of absence and then files a claim, eligibility is based on the reason for the discharge.

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California Leave of Absence Application Form