Hawaii 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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FAQ

Please be advised that I hereby request an FMLA leave for a period of (number of weeks) in connection with my serious health condition. The leave is to start on (date). Attached is my medical note reflecting the need for FMLA leave. Please let me know whether you approve this leave at your earliest convenience.

Under the FMLA, a serious health condition is an illness, injury, impairment or physical or mental condition that involves inpatient care (defined as an overnight stay in a hospital, hospice or residential medical care facility; any overnight admission to such facilities is an automatic trigger for FMLA eligibility) or

20,000 federal workers in Hawai02bbi will be receiving paid parental leave under the Federal Employee Paid Leave Act. Signed into law in December 2019, this grants employees up to 12 weeks of paid time off for the birth, adoption, or fostering of a new child, starting in October 2020.

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.

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.

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.

Eligibility Under the FMLAAll types of employees are eligible.The employee must have worked for the State of Hawai'i for at least 12 months (need not be consecutive), and.The employee must have worked at least 1,250 hours over the 12-month period immediately preceding the employee's leave.

Here's how to ask for a leave of absence from your job:Understand your legal rights regarding time off and pay.Make the request in person.Give sufficient advance notice.If possible, work with your boss to develop an agreeable plan.Keep track of relevant paperwork.

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.

15. Q: Is paid sick leave under HFLL available to an employee for the birth of the employee's child who does not have a serious health condition? A: Yes. The new law specifies that the use of accrued and available sick leave is for family leave purposes, which includes the birth or adoption of a child.

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Hawaii Application for Family Medical Leave of Absence