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.
Connecticut Employee Application for FMLA is a formal document used by employees in the state of Connecticut to apply for leave under the Family and Medical Leave Act (FMLA). This application is designed to ensure that eligible employees who need time off for specific family and medical reasons are granted protected leave without any negative consequences of their employer. The Connecticut Employee Application for FMLA is an essential tool that allows employees to request leave for a variety of FMLA qualifying reasons, including: 1. Birth and care of a newborn child: Employees can use this application to take FMLA leaves to bond with and care for a newborn child within the first year after birth. 2. Placement and care of an adopted or foster child: If an employee is adopting or fostering a child, they can apply for FMLA leave using this application to provide care and bond with the newly placed child. 3. Serious health condition: Employees suffering from a serious health condition can request FMLA leave using this application. This includes conditions that require inpatient care, continuing treatment by a healthcare provider, or chronic illnesses that cause periodic absences. 4. Care for an immediate family member with a serious health condition: When an employee's immediate family member (spouse, child, or parent) is facing a serious health condition, they can apply for FMLA leave through this application to provide necessary care and support. 5. Qualifying exigency: In case an employee's spouse, child, or parent is a military member on covered active duty or is called to covered active duty status, they may be eligible for FMLA leave to address qualifying exigencies, such as attending certain military events or making childcare arrangements. The Connecticut Employee Application for FMLA requires employees to provide relevant information, including their name, contact details, employee identification, work unit, supervisor details, the leave requested (start and end dates), purpose of leave, and necessary medical documentation where applicable. Employees should also provide any supporting documentation or details that substantiate their need for FMLA leave. It is important to note that there may be variations in the specific format or additional requirements for the Connecticut Employee Application for FMLA across organizations and industries. Employees are advised to consult their employer's FMLA policy or Human Resources department for the exact application form and any additional guidelines.
