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.
Tennessee Employee Application for FMLA
State:
Multi-State
Control #:
US-AHI-200
Format:
Word
Instant download
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How to fill out Employee Application For FMLA?
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FAQ
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.
(A) In order to be eligible to take leave under the FMLA, an employee must:work for a covered employer;have worked 1,250 hours during the 12 months prior to the start of leave;work at a location where the employer has 50 or more employees within 75 miles; and.have worked for the employer for 12 months.
Doctors aren't the only health care providers who may certify FMLA leave. Podiatrists, dentists, clinical psychologists, optometrists and chiropractors can all certify leave, as can nurse practitioners, nurse-midwives, clinical social workers and physician assistants.
FMLA leave is unpaid, but employees may be allowed (or required) to use their accrued paid leave during FMLA leave. When an employee's FMLA leave ends, the employee is entitled to be reinstated to the same or an equivalent position, with a few exceptions.
(A) In order to be eligible to take leave under the FMLA, an employee must:work for a covered employer;have worked 1,250 hours during the 12 months prior to the start of leave;work at a location where the employer has 50 or more employees within 75 miles; and.have worked for the employer for 12 months.
Paid Family Leave provides an employee with up to 30 work days (typically 6 weeks) of leave to take care of a spouse, son, daughter, or parent who has a serious health condition.
According to Tennessee law, any employee who has been employed as a full-time employee for at least 12 consecutive months may take up to four months of leave for pregnancy, childbirth, nursing of an infant, or adoption of a child (defined as beginning at the time employee takes custody of the child).
According to Tennessee law, any employee who has been employed as a full-time employee for at least 12 consecutive months may take up to four months of leave for pregnancy, childbirth, nursing of an infant, or adoption of a child (defined as beginning at the time employee takes custody of the child).
(A) 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.