Maryland Family and Medical Leave Request Form
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How to fill out Family And Medical Leave Request Form?
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FAQ
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.
Like employers in every state, Maryland employers must follow the federal Family and Medical Leave Act (FMLA), which allows eligible employees to take unpaid leave, with the right to reinstatement, to attend to certain health and family matters.
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.
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
With the enactment of the law, Maryland becomes the latest state to establish paid family and medical leave for employees. The Act creates a family and medical leave fund (the Fund) which provides temporary paid leave benefits to covered employees and participating self-employed individuals.
I am writing to inform you that I will be taking a sick leave because of a serious infection in my throat. I will be absent from work until October 14. I have attached a note from my doctor to confirm that it is necessary for my health and the health of my coworkers for me to take a medical leave.
To be eligible for FMLA benefits, an employee must: Have worked at least 1,250 hours over the previous 12 months; and. Work at a location in the United States or in any territory or possession of the United States where at least 50 employees are employed by the employer within 75 miles.