Iowa 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

To take FMLA leave, you must provide your employer with appropriate notice. If you know in advance that you will need FMLA leave (for example, if you are planning to have surgery or you are pregnant), you must give your employer at least 30 days advance notice.

200bYes. Please contact your employer regarding potential telecommuting, sick leave, PTO, FMLA, Disability and other options they may be offering.

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.

Although FMLA leave is unpaid, employees may choose or employers may require employees to use accrued paid leave, such as sick or vacation leave, to cover some or all of the FMLA leave period. An employee's ability to take paid leave during FMLA leave depends on the employer's normal leave policies.

The FMLA only requires unpaid leave. However, the law permits an employee to elect, or the employer to require the employee, to use accrued paid vacation leave, paid sick or family leave for some or all of the FMLA leave period.

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

To designate FMLA, managers and supervisors must contact their Human Resources Associate (HRA). Any requests for exceptions, 2nd opinions, or FMLA designations must be submitted by the agency's HRA to FMLA@iowa.gov.

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Iowa Application for Family Medical Leave of Absence