North Dakota Application for Family Medical Leave of Absence

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Multi-State
Control #:
US-425EM
Format:
Word; 
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Description

This form may be used by an employee to request leave under the FMLA.
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How to fill out Application For Family Medical Leave Of Absence?

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FAQ

Employees are eligible if they have worked for a covered employer for at least one year, for 1,250 hours over the previous 12 months, and if at least 50 employees are employed by the employer within 75 miles. participating in school or other daily activities.

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.

Some common reasons employees take a leave of absence are to recover from a serious illness, undergo a medical procedure, assist a family member, take an extended trip or welcome a new child into the family.

Here's how to ask for a leave of absence from your job:Understand your legal rights regarding time off and pay.Make the request in person.Give sufficient advance notice.If possible, work with your boss to develop an agreeable plan.Keep track of relevant paperwork.

North Dakota does not have a paid leave program of any kind.

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.

Below is a summary and descriptions of reasons that qualify for FMLA leave under current FMLA regulations.Parental Leave after the Birth of a Child.Pregnancy Leave.Adoption or Foster Care.Medical Leave to Care for a Family Member with a Serious Health Condition.Medical Leave for Your Own Serious Health Condition.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

Sample LetterI 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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North Dakota Application for Family Medical Leave of Absence