Oklahoma 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

The federal Family and Medical Leave Act (FMLA) provides up to 12 weeks of leave for many workers. Though this leave is unpaid, it does provide job security and continuation of health benefits for eligible workers.

Growth Trends for Related Jobs If you're covered by the law, you aren't required to ask a doctor for a written excuse before requesting time off. However your employer is within its rights to ask for a doctor's certification, which confirms that you have legitimate FMLA reasons for your absence.

In Oklahoma, employers must comply with the FMLA if they have at least 50 employees for at least 20 weeks in the current or previous year. Employees may take 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.

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.

Sample LetterSmith, I 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.

The first 12 weeks of leave taken for a work-related injury are designated as FMLA leave, if the employee is eligible for FMLA leave and chooses not to supplement temporary total disability (TTD) payments with sick leave, annual leave, compensatory time or compensatory holiday leave.

FMLA allows you to take up to 12 weeks of unpaid leave in a 12-month period and more than twice that amount (26 weeks over 12 months) if you're a military caregiver. If your employer provides group health benefits to you, it must maintain them during your time off.

The FMLA only requires unpaid leave. However, the law permits an employee to elect, or the employer to require the employee, to use accrued paid vacation leave, paid sick or family leave for some or all of the FMLA leave period.

Dear (Supervisor / HR Manager): Please be advised that I hereby request an FMLA leave for a period of (number of weeks) in connection with my serious health condition. The leave is to start on (date). Attached is my medical note reflecting the need for FMLA leave.

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.

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Oklahoma Application for Family Medical Leave of Absence