Washington 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

First submit the medical leave application and documentation....3. Upload documentsProof of identification.Certification of a Serious Health Condition (if applicable).Certification of Birth form (if applicable).Documentation for child placement (if applicable).Military family leave documents (if applicable).

PFML and FMLA are separate entitlements and should be treated differently. PFML is a statewide insurance program that provides wage replacement, along with job protections, similar to FMLA (if eligible). FMLA is a federal entitlement providing job protections and insurance maintenance for employees who qualify.

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.

Processing times: Our goal is to process complete applications within three weeks.

Benefits provide a percentage of the employee's gross wages between $100-1,000 per week while the employee is on approved leave. To receive benefits under the Paid Family and Medical Leave program, you must have worked a total of at least 820 hours for any Washington employers during the previous 12 months.

Once your application is approved, you can expect weekly payments to begin 2-4 weeks after your leave begins.

Processing times: Our goal is to process complete applications within three weeks.

Benefits provide a percentage of the employee's gross wages between $100-1,000 per week while the employee is on approved leave. To receive benefits under the Paid Family and Medical Leave program, you must have worked a total of at least 820 hours for any Washington employers during the previous 12 months.

An employee becomes eligible for Paid Family and Medical Leave benefits once they have completed 820 hours of work for any employer/s in Washington State in the qualifying period.

How do I apply for leave? You can apply online or with a paper application. To request the paper application contact us at (833) 717-2273.

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Washington Application for Family Medical Leave of Absence