Indiana Family and Medical Leave Request Form
Description
How to fill out Family And Medical Leave Request Form?
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FAQ
Dear (Name of the employer), I am writing the letter to request you to hold my unbalanced medical leave as an outcome (diagnosed disorder) as this includes a complete break owing to my absence. Because my surgeon has issued me with a medical certificate, I have sealed it.
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.
Dear Supervisor's First Name, I am writing this email to inform you I will be on sick leave from mention dates due to mention reason of your sickness. I have attached my medical documents and the letter from my doctor stating the number of days off I need to take from work to recover completely.
In addition to the federal Family and Medical Leave Act (FMLA), some states have their own comprehensive family leave laws that may also require employers to grant employees time off for the birth or adoption of a child or to care for a family member with a serious illness. However, Indiana does not have such a law.
When am I eligible for time off under the FMLA? You must have worked for your employer for at least 12 months and you must have worked for at least 1,250 hours during the last year. The employer must have at least 50 or more employees within 75 miles of where you work.
I am writing to you to let you know that I have an important personal matter to attend at my hometown due to which I will not be able to come to the office from {start date} to {end date}. I have discussed and delegated my tasks to {person's name} & have instructed them to call me for any help during my absence.
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
FMLA leave is unpaid, but employees may be allowed (or required) to use their accrued paid leave during FMLA leave. When an employee's FMLA leave ends, the employee is entitled to be reinstated to the same or an equivalent position, with a few exceptions.
How to ask for a leave of absenceCheck 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.03-Dec-2021
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.
