Utah Application for Family Medical Leave of Absence
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How to fill out Application For Family Medical Leave Of Absence?
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FAQ
I will be having surgerymy surgeon has ordered a minimum three-week recovery period (see doctor's signed recommendation attached.) I am happy to assist in handling any necessary preparations before beginning my leave, including training colleagues on upcoming projects. Thank you so much for your understanding.
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.
The FMLA gives eligible employees in Utah the right to take up to 12 weeks off work per year for pregnancy or parenting leave. The FMLA applies only to employers with at least 50 employees. If you qualify, you can use the FMLA to take time off when you are unable to work because of your pregnancy and childbirth.
To be eligible for FMLA you must have a qualifying event and have been employed with the State for 12 months and worked at least 1,250 hours in the 12 months immediately preceding the first day of the leave requested for FMLA.
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.
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
Include a brief explanation of why you are taking the leave and perhaps state where you will be while you are away. If it is possible, offer your assistance and provide the best way to contact you during your time off. Be sure to thank your employer for considering your request.
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.
In addition to the federal Family and Medical Leave Act (FMLA), some states have their own comprehensive family leave laws that may also require employers to grant employees time off for the birth or adoption of a child or to care for a family member with a serious illness. However, Utah does not have such a law.
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.