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.
Wisconsin Employee Application for FMLA: The Wisconsin Employee Application for Family and Medical Leave Act (FMLA) is a crucial document that allows eligible employees in the state of Wisconsin to request protected leave for qualified family and medical reasons. This application is specifically designed for employees seeking to take advantage of the provisions granted by the federal FMLA, which entitles eligible employees to up to 12 weeks of unpaid leave within a 12-month period. Key Features and Requirements: 1. Eligibility: To be eligible for FMLA leave in Wisconsin, employees must have worked for their employer for at least 1,250 hours over the previous 12 months and be employed at a worksite with at least 50 employees within a 75-mile radius. Additional requirements may be outlined by the employer regarding specific time-off policies and documentation. 2. Reasons for Leave: The Wisconsin Employee Application for FMLA provides options for various qualifying reasons, including: a. Birth, adoption, or foster placement of a child. b. Caring for a spouse, child, or parent with a serious health condition. c. Personal serious health condition that renders the employee unable to perform essential job functions. d. Qualifying exigencies due to a covered family member's military service. e. Caring for a covered service member with a serious injury or illness (military caregiver leave). 3. Application Process: Employees are required to complete the Wisconsin Employee Application for FMLA and submit it to their employer. The application typically includes essential information such as the employee's name, date, employee ID, department, contact details, supervisor's name, and the specific reason for the requested leave. 4. Medical Certification: In most cases, the employee's medical certification or relevant supporting documentation must accompany the application. This documentation should provide details about the nature of the condition or circumstance requiring leave and expected duration or intermittent leave schedules, if applicable. The employer has the right to request an opinion from a second healthcare provider if they have a permissible reason to doubt the validity of the initial medical certification. Types of Wisconsin Employee Application for FMLA: 1. Initial FMLA Application: This form is typically used when an employee requests FMLA leaves for the first time or when there has been a significant change in the covered circumstance requiring the leave. 2. Renewal FMLA Application: If an employee seeks an extension of their existing FMLA leave beyond the initially approved timeframe, they may need to submit a Renewal FMLA Application. This application provides updated medical certification or documentation supporting the need for continued leave. 3. Intermittent FMLA Application: When an employee requires intermittent or reduced schedule FMLA leave due to a serious health condition or qualifying exigencies, they can use this application to outline the specific periods or hours needed for leave. Remember, each employer may have its own specific FMLA application forms or processes, so it is essential for employees to consult their Human Resources department or employer's policies for the precise application requirements. Keywords: Wisconsin, Employee Application, FMLA, Family and Medical Leave Act, eligibility, protected leave, unpaid leave, qualifying reasons, birth, adoption, foster placement, serious health condition, military service, medical certification, intermittent leave, initial FMLA application, renewal FMLA application, intermittent FMLA application.
