New York Application for Family Medical Leave of Absence

State:
Multi-State
Control #:
US-425EM
Format:
Word; 
Rich Text
Instant download

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 for leave if they have worked for their employer at least 12 months, at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles.

EligibilityHave worked for your employer for at least 12 months; and.Have worked for your employer for at least 1,250 hours in the 12 months before you are taking leave; and.Work at a location where your employer has at least 50 employees within 75 miles of your worksite.

To apply for leave under FMLA, contact the personnel office of your employer agency. If eligible and approved, the personnel office will provide to the Fund's administrative office the appropriate information for continuation of Fund benefits.

The key difference in FMLA vs PFL is that FMLA is not a paid leave. It offers no compensation to employees taking time off. PFL in New York, on the other hand, provides both job protection and income for employees on leave.

FMLA leave is unpaid, but employees may be allowed (or required) to use their accrued paid leave during FMLA leave. And, if you are taking leave for a reason covered by New York's temporary disability insurance or paid family leave programs, you may be eligible for benefits during your time off; see below.

Employees are eligible for leave if they have worked for their employer at least 12 months, at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles.

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

For 2020, you are allowed to take up to 10 weeks of Paid Family Leave in a 12-month period and you will receive 60% of your average weekly wage, capped at $840.70. That maximum amount, however, is equal to 60% of the State Average Weekly Wage of $1,401.17.

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New York Application for Family Medical Leave of Absence