Oregon Family and Medical Leave Request Form

State:
Multi-State
Control #:
US-266EM
Format:
Word; 
Rich Text
Instant download

Description

An employee may use this form to request leave under the FMLA.
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  • Preview Family and Medical Leave Request Form
  • Preview Family and Medical Leave Request Form
  • Preview Family and Medical Leave Request Form
  • Preview Family and Medical Leave Request Form

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FAQ

A: Leaves that qualify under both OFLA and FMLA will run concurrently, with an employee generally being entitled to a total of 12 weeks of protected leave.

Employees are entitled to continue their health insurance while on leave, at the same cost they must pay while working. FMLA leave is unpaid, but employees may be allowed (or required) to use their accrued paid leave during FMLA leave.

FMLA states that an employee returning from leave is entitled to his or her former job or an equivalent job with the same pay and benefits. OFLA states that an employee returning from leave is entitled to the former job, or to an available equivalent job if the employee agrees or if the former job has been eliminated.

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

Oregon paid family leave is a program that grants eligible Oregon employees up to 12 weeks of paid time off for family or medical leave or to address a domestic violence situation. Oregon is one of the most generous paid family leave states.

An employee who has earned at least $1,000 in wages in the calendar year is eligible for Oregon paid family leave. Both full-time and part-time employees can qualify for Oregon paid family leave. Oregon employees can use PFL to: Bond with a child (birth, adoption, or foster care placement)

Employers in Oregon are subject to the FMLA if they have at least 50 employees for at least 20 weeks in the current or previous year. 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.

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.

Leave and Reinstatement Rights Employees are entitled to continue their health insurance while on leave, at the same cost they must pay while working. FMLA leave is unpaid, but employees may be allowed (or required) to use their accrued paid leave during FMLA leave.

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Oregon Family and Medical Leave Request Form