Maine Family and Medical Leave Request Form

State:
Multi-State
Control #:
US-266EM
Format:
Word; 
Rich Text
Instant download

Description

An employee may use this form to request leave under the FMLA.
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  • Preview Family and Medical Leave Request Form
  • Preview Family and Medical Leave Request Form

How to fill out Family And Medical Leave Request Form?

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FAQ

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. Please let me know whether you approve this leave at your earliest convenience.

1. Family medical leave entitlement. Every employee who has been employed by the same employer for 12 consecutive months is entitled to up to 10 work weeks of family medical leave in any 2 years unless employed at a permanent work site with fewer than 15 employees.

26, § 637), enacted in 2019, allows Maine workers to accrue one hour of paid leave for every 40 worked, up to 40 total hours per year, to use for any reason after 120 days of employment. The measure applies starting Jan. 1, 2021, and preempts any similar local laws in the state.

There is no paid family leave in Maine. While some businesses have disability insurance policies that allow for paid leave, there is no state mandated guarantee of paid leave. However, beginning in 2021, public and private employers with 25 or more employees will be required to provide paid leave.

Include a brief explanation of why you are taking the leave and perhaps state where you will be while you are away. If it is possible, offer your assistance and provide the best way to contact you during your time off. Be sure to thank your employer for considering your request.

Key TakeawaysNine states (California, Colorado, Connecticut, Massachusetts, New Jersey, New York, Oregon, Rhode Island, and Washington) and the District of Columbia offer PFML.Of the states that have PFML policies currently on the books, six and D.C. are presently in effect.More items...

Employees are eligible for FMLA leave if: they have worked for the company for at least a year. they worked at least 1,250 hours during the previous year, and. they work at a location with at least 50 employees within a 75-mile radius.

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.

Once payments have started, you can log into your account and check your payment status each week. When you begin your paid family or medical leave, there is a 7-day waiting period before benefit payments start. You will not receive benefit payments during this waiting period.

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.

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Maine Family and Medical Leave Request Form