Michigan Family and Medical Leave Request Form
Description
How to fill out Family And Medical Leave Request Form?
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FAQ
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 Michigan, employers must (as of March 29, 2019) allow employees to accrue up to 1 hour of sick leave for every 35 hours worked. The act further requires that an employer shall allow an eligible employee to use up to 40 hours of sick leave per 12-month period of eligibility.
Your request for a leave of absenceDuring the first paragraph of your letter, state your request for a leave of absence. This is where you include the start date of your absence and the approximate return date. You can include your reason for a leave of absence with as much detail as you feel comfortable with.
To apply for a medical leave of absence:Submit your application: Online, or. Print, complete and fax an Application for Leave of Absence.Have your treating physician complete one of the following: FMLA Certification of a Serious Health Condition, or. Non-FMLA Medical Certification. Not sure if you qualify under the FMLA?
How Much FMLA Leave Is Available in Michigan? Michigan workers have up to 12 weeks FMLA in a 12-month time frame for health conditions, new babies, or other circumstances. These weeks renew every year as long as the worker meets eligibility requirements.
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, you must have 12 months of employment with the State of Michigan (does not need to be consecutive) and you must have physically worked 1,250 hours within the previous 12 months. For questions on FMLA eligibility, contact the Disability Management Unit (DMU) by phone at 877-443-6362.
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
Although FMLA leave is unpaid, 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.
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.
