Connecticut 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

You can apply online or call the toll-free application line at (877) 499-8606. To apply online, create an account with CT Paid Leave. Get started with this step-by-step instructional video. If you know when you will be taking leave, submit your application no more than 30 days before the leave start date.

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 state of Connecticut FMLA allows up to 16 weeks of unpaid leave in a 24-month period (or up to 24 weeks if you are a state of Connecticut employee). Pregnancy: The Connecticut FMLA allows up to 12 weeks of unpaid leave in a 12-month period.

You can apply online or call the toll-free application line at (877) 499-8606. To apply online, create an account with CT Paid Leave. Get started with this step-by-step instructional video. If you know when you will be taking leave, submit your application no more than 30 days before the leave start date.

Visit the Connecticut Department of Labor's website at or call 860-263-6790. Visit the U.S. Department of Labor's website at or call 866-487-9243.

According to FAQs on the CT Paid Leave Authority website, approved applicants will generally receive benefits on a weekly basis, and funds will be paid each Tuesday two weeks after a week of leave is completed. The Authority provides an example of taking from Jan.

According to the CT Paid Leave Authority, those eligible to receive family leave benefits must be currently employed in Connecticut, have worked in Connecticut in the past 12 weeks but are currently unemployed or are a sole proprietor or self-employed person and resident of Connecticut.

Care for a family member with a serious health condition; Because of an employee's own serious health condition; To serve as an organ or bone marrow donor; To address qualifying exigencies arising from a spouse, son, daughter or parent's active-duty service in the armed forces; and.

A paid family leave law described as one of the most generous in the country goes into effect for Connecticut workers on January 1, 2022. Workers will be able to take 12 weeks of paid leave in 12 months for personal and family health needs.

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Connecticut Family and Medical Leave Request Form