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.
Maryland Employee Application for FMLA
State:
Multi-State
Control #:
US-AHI-200
Format:
Word
Instant download
Description
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How to fill out Employee Application For FMLA?
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FAQ
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.
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
Under MFLA, insurance provided under Employee Retirement Income Security Act plan, workers and unemployment compensation benefits; and disability benefits are excluded from "leave with pay." Only those employees who are primarily employed in the state are covered.
To be eligible for FMLA benefits, an employee must:Work for a covered employer;Have worked for the employer for a total of 12 months;Have worked at least 1,250 hours over the previous 12 months; and.More items...?
FMLA is a federal law providing for an unpaid period of protected absence of up to 12 weeks, or up to 26 weeks for Military Caregiver Leave, in a twelve-month period for a qualifying event (see FMLA Fact Sheet for more qualifications).
Under the FMLA, eligible employees can take up to 12 workweeks of leave per 12-month periods without losing their job or health insurance. The guaranteed leave can be unpaid, and any paid leave can run concurrent to the FMLA leave at the employer's discretion.
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.
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.
FMLA leave is unpaid, but employees may be allowed (or required) to use their accrued paid leave during FMLA leave.