West Virginia Family and Medical Leave Request Form

State:
Multi-State
Control #:
US-266EM
Format:
Word; 
Rich Text
Instant download

Description

An employee may use this form to request leave under the FMLA.
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  • Preview Family and Medical Leave Request Form
  • Preview Family and Medical Leave Request Form
  • Preview Family and Medical Leave Request Form

How to fill out Family And Medical Leave Request Form?

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FAQ

FMLA leave is unpaid, and West Virginia does not have a paid family leave law or paid short-term disability benefits. However, you may askor your employer may require youto use your accrued paid leave (like sick days, vacation, or PTO) to get paid during your time off.

California's new Parental Leave Act (PLA) provides up to 12 weeks of leave for new parents. This includes parents who have given birth to a child and parents who have had a child placed with them through foster care or adoption.

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. If an employer requests it, an employee is required to provide a complete and sufficient medical certification in order to take FMLA-protected leave due to a serious health condition. The employer cannot ask for a diagnosis.

The FMLA entitles eligible employees to take up to 12 weeks of unpaid, job protected leave in a 12-month period, for specified family and medical reasons including any qualifying exigency arising out of the active duty or call to active duty status of a spouse, son, daughter or parent.

West Virginia's Parental Leave Act provides all state and county employees with up to 12 weeks of unpaid leave during any 12-month period. This unpaid leave is provided after the exhaustion of the employee's entire annual and personal leave.

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

If you are an eligible employee working for a covered employer, you are entitled to up to 12 weeks of unpaid leave in a 12-month period for any of the circumstances listed. You are also entitled to the following: Return to your job, or an equivalent job.

Public-Sector Employers: West Virginia's Parental Leave Act provides all state and county employees with up to 12 weeks of unpaid leave during any 12-month period. This unpaid leave is provided after the exhaustion of the employee's entire annual and personal leave.

To be eligible for unpaid leave under the FMLA, an employee must have worked for the employer for at least 12 months and worked for at least 1,250 hours during the previous 12 months.

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West Virginia Family and Medical Leave Request Form