Colorado Family and Medical Leave Request Form

State:
Multi-State
Control #:
US-266EM
Format:
Word; 
Rich Text
Instant download

Description

An employee may use this form to request leave under the FMLA.
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  • Preview Family and Medical Leave Request Form
  • Preview Family and Medical Leave Request Form
  • Preview Family and Medical Leave Request Form

How to fill out Family And Medical Leave Request Form?

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FAQ

Employees are eligible for FMLA leave if: they have worked for the company for at least a year. they worked at least 1,250 hours during the previous year, and. they work at a location with at least 50 employees within a 75-mile radius.

Law and Policy Group Colorado moves forward on paid family and medical leave. Colorado has adopted its first Family and Medical Leave Insurance (FAMLI) program regulations for private employers and self-employed individuals, developed a dedicated website and proposed the next round of rules.

Covered individuals will receive paid leave amounting to:90% of their average weekly wage for the portion of their wages equal to or less than 50% of the state average weekly wage; and.50% of the portion of their wages that exceeds the state average weekly wage.

To apply for FMLA, the employee must take an FMLA Medical Certification Form to their health care provider. This form ensures that the employee's or family member's applicable health condition is valid. After receiving the form, the employee must return it within 15 calendar days.

Currently, the State of Colorado provides eligible employees with up to 480 hours of FML and up to 40 hours of state family medical leave based on a "rolling" 12-month period measured backward from the date an employee begins using FMLA leave.

The FMLA gives eligible employees the right to take up to 12 weeks off work in a one-year period for pregnancy and parenting leave (among other things). If you qualify, you may use the FMLA to take time off when you are unable to work because of your pregnancy and childbirth.

The Colorado Family Care Act (FCA) was signed into law on by Governor Hickenlooper. The law was created under the premise that the State of Colorado legislators wanted to create additional coverage for employees above that which was provided by the Federal Family and Medical Leave Act (FMLA).

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

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Colorado Family and Medical Leave Request Form