This form is an application for Family and Medical Leave. It is to be filled out by an employee who is requesting a leave of absence.
New Jersey Employee Application for FMLA
State:
Multi-State
Control #:
US-AHI-200
Format:
Word;
Rich Text
Instant download
Description
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How to fill out Employee Application For FMLA?
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FAQ
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.
Eligible employees may take family leave for up to 12 weeks within any 24-month period, provided the employee makes a reasonable effort to schedule the leave so as to not unduly disrupt the employer's operation. Public employees may use a voluntary furlough of up to 30 work days for FLA or FMLA purposes.
New Jersey Family Leave Act (NJFLA) If your employer is covered under the NJFLA and you are an eligible employee, then you are generally entitled to up to 12 weeks of job-protected leave to care for a loved one in a two-year period.
Sometimes employers wrongfully deny workers FMLA leave, or even fire them for taking such leave. Luckily, the FMLA prohibits employers from interfering with the exercise of workers' FMLA rights, and firing a worker in retaliation for taking FMLA leave is illegal.
The law allows employees wrongfully denied FMLA leave to file suit and if successful, recover damages for losses or harm suffered as a result. An employment attorney can help you file a legal claim against your employer to receive this compensation.
Claimants are paid 85% of their average weekly wage, up to the maximum weekly benefit rate set for that calendar year. In 2021, the maximum weekly benefit rate is $903 per week. In 2022, the maximum weekly benefit rate is $993 per week.
Employees are eligible for leave under New Jersey's family and medical leave law if they have worked for their employers for at least one year, and have worked at least 1,000 hours in the last 12 months. Employees may take leave to care for a parent, spouse, child, parent-in-law, or partner in a civil union.
You can apply online, which is the easiest way to apply for benefits.You can download, print, and fill out a paper application (FL-1), and mail it back to us at Division of Temporary Disability & Family Leave Insurance, P.O. Box 387, Trenton, NJ 08625-0387, or fax it to 609-984-4138.
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.
