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.
Iowa Employee Application for FMLA
State:
Multi-State
Control #:
US-AHI-200
Format:
Word;
Rich Text
Instant download
Description
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How to fill out Employee Application For FMLA?
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FAQ
I will be having surgerymy surgeon has ordered a minimum three-week recovery period (see doctor's signed recommendation attached.) I am happy to assist in handling any necessary preparations before beginning my leave, including training colleagues on upcoming projects. Thank you so much for your understanding.
Dear (Supervisor / HR Manager): 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.
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.
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.
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
How Do I Request FMLA Leave? 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.
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.
200bYes. Please contact your employer regarding potential telecommuting, sick leave, PTO, FMLA, Disability and other options they may be offering.
