Nebraska Request for Extended Personal Leave

State:
Multi-State
Control #:
US-300EM
Format:
Word; 
Rich Text
Instant download

Description

This form is used by an employee to request an extended leave of absence.
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FAQ

Under the FMLA, a serious health condition is an illness, injury, impairment or physical or mental condition that involves inpatient care (defined as an overnight stay in a hospital, hospice or residential medical care facility; any overnight admission to such facilities is an automatic trigger for FMLA eligibility) or

A leave of absence is an extended period of time off from your job. 1feff Depending on the organization, you may simply be able to ask for time off from work. Or there may be a formal process you need to follow to get approved for a leave of absence.

FMLA leave is unpaid, and Nebraska does not have a paid family leave law or offer paid short-term disability benefits. However, you may askor your employer may require youto use your accrued paid leave (like sick days, vacation, or PTO) to get paid during your time off.

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.

Casual leave application: Sample 1 Dear Mr./Mrs. {Recipient's Name}, I am writing to you to let you know that I have an important personal matter to attend at my hometown due to which I will not be able to come to the office from {start date} to {end date}.

The Federal Family and Medical Leave Act (FMLA) requires some employers to provide up to 12 weeks unpaid leave for workers to care for a new child, sick family member, or recover from an illness.

Employees are eligible for FMLA leave if they: have worked for the employer for at least a year. have worked at least 1,250 hours during the 12 months prior to taking leave, and. work at a location where the employer has at least 50 employees within a 75-mile radius.

In order for an employee to be eligible to take FMLA leave due to stress, the stress must be so severe that it amounts to a serious health condition which renders the employee unable to perform the tasks required by his or her job.

Kindly grant me leave for a day on {date}. In case, I need to take extra days to recuperate, I will inform you at the earliest. Please feel free to contact me at my personal phone number in case of any questions or clarifications about ongoing work at the office.

I am writing to you to let you know that I have an important personal matter to attend at my hometown due to which I will not be able to come to the office from {start date} to {end date}. I have discussed and delegated my tasks to {person's name} & have instructed them to call me for any help during my absence.

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Nebraska Request for Extended Personal Leave