Minnesota 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
  • Preview Family and Medical Leave Request Form

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FAQ

CAN YOU COLLECT UNEMPLOYMENT BENEFITS WHILE ON FMLA LEAVE? Generally no, you are not eligible for unemployment benefits if you take medical leave under the Family and Medical Leave Act and you cannot work. 2. The employee is on a leave of absence while he or she is unable to work or unavailable for work.

To apply for FMLA, the employee must take an FMLA Medical Certification Form to their health care provider. This form ensures that the employee's or family member's applicable health condition is valid. After receiving the form, the employee must return it within 15 calendar days.

The Minnesota State Parental Leave Act covers you if your employer has at least 21, but less than 50, employees. It only covers leave if you have a child, not other types of medical leave. The Department of Labor has more information about this law.

To be eligible for FMLA benefits, you must:Work for an employer to whom the FMLA applies.Have been employed by the employer for at least 12 months.Have worked for at least 1,250 hours during the 12-month period right before the start of the leave.More items...

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

Eligibility - all working Minnesotans, including small business owners & those self-employed are eligible for up to 12 weeks of medical leave & up to 12 weeks of family leave.

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.

The federal Family Medical Leave Act FMLA requires employers to provide up to 12 weeks of unpaid leave in connection with the birth or adoption of a child or for a serious health condition. You may be entitled to additional leave under FMLA for a nonpregnancy-related serious health condition.

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Minnesota Family and Medical Leave Request Form