Virginia 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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FAQ

The first bill prefiled for the 2022 Virginia Legislative Session could secure up to 12 weeks of paid family and medical leave, benefitting caregivers across the commonwealth.

The Family and Medical Leave Act (FMLA) provides certain employees with up to 12 weeks of unpaid, job-protected leave per year. It also requires that their group health benefits be maintained during the leave.

There is no Virginia law requiring private sector employers to provide employees sick leave, paid or unpaid, although many employers do grant it as an important employee benefit. It is important to remember, however, that if sick leave is promised, an employer may create a legal obligation to grant it.

Virginia 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.

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.

Paid family and medical leave program.Requires the Virginia Employment Commission to establish and administer a paid family and medical leave program with benefits beginning January 1, 2024. Under the program, benefits are paid to eligible employees for family and medical leave.

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. Please let me know whether you approve this leave at your earliest convenience.

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

All full-time and part-time classified, restricted and wage employees who have been employed by the Commonwealth for a total of at least 12 months in the past seven years and have worked for at least 1,250 hours in the previous 12-month period are eligible.

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Virginia Application for Family Medical Leave of Absence