Massachusetts Request for Extended Personal Leave

State:
Multi-State
Control #:
US-300EM
Format:
Word; 
Rich Text
Instant download

Description

This form is used by an employee to request an extended leave of absence.
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How to fill out Request For Extended Personal Leave?

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FAQ

Extended leave encompasses forms of leave with or without pay that last longer than 15 consecutive workdays. Extended leave may be provided for medical (self and family), parental, military, and personal reasons.

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.

You may also order another Claim for Paid Family Leave (PFL) Benefits (DE 2501F). Another option is to extend your claim through a verbal certification by calling 1-877-238-4373 if you have not returned to work or had a break in certification from your current bonding period.

For this purpose, I need leave for at least two more weeks, starting from (starting date) till (end date). I am attaching the necessary reports and doctors' certificates with this email. Kindly put me in touch with someone I can speak to about the company medical insurance for employees.

Another option is to extend your claim through a verbal certification by calling 1-877-238-4373 if you have not returned to work or had a break in certification from your current bonding period. For PFL military assist claims, if you wish to extend your claim, you may order another DE 2501F.

When requesting a formal leave of absence, your letter should include:Request for a leave of absence,The dates you expect to be away from work,The date you plan to return to work,An offer to provide assistance, if feasible,Thanks for considering your request.

There is no formal provision in the FMLA for extended leave beyond 12 weeks. However, it is possible for workers to negotiate an extension on a case-by-case basis by discussing their situation with their employer and requesting additional unpaid leave during a family or medical crisis.

If you need to extend your leave, you must call the Contact Center to request an extension at least 14 calendar days before the expiration of your original leave. You can call the Department's Contact Center at (833) 344-7365 to request an extension and send us your documentation as soon as it is available.

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Massachusetts Request for Extended Personal Leave