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.
Illinois Employee Application for FMLA
State:
Multi-State
Control #:
US-AHI-200
Format:
Word
Instant download
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How to fill out Employee Application For FMLA?
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FAQ
Paid leave or unpaid? Normally, FMLA leave is unpaid. This means that you do not receive a salary or other wage during the leave period.
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.
Simply put, your employer must refrain from sharing the reasons for your FMLA leave. The reason that the employer shares your private information is irrelevant. Your boss may just want to tell people you're doing OK.
Employees are eligible for leave if they have worked for their employer at least 12 months, at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles.
Doctors aren't the only health care providers who may certify FMLA leave. Podiatrists, dentists, clinical psychologists, optometrists and chiropractors can all certify leave, as can nurse practitioners, nurse-midwives, clinical social workers and physician assistants.
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.
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
You have a right under the FMLA to take unpaid, job-protected FMLA leave in a 12-month period for certain family and medical reasons, including up to 12 weeks of unpaid leave in a 12-month period for the birth of a child or placement of a child for adoption or foster care, for a leave related to your own or a family
Use these steps to ask your employer for a leave of absence:Check company policies. Before making a request for a leave of absence, check your company's policies by looking at your employee handbook or contacting an HR representative.Speak to your supervisor.Put your request in writing.Give advance notice.Offer to help.
While the employee is on leave, an employer can ask the employee to provide status updates, including asking the employee to obtain a second opinion regarding her condition. The caveat is that you may only ask the employee; you cannot ask anyone else about a particular employee's leave.