West Virginia Application for Family Medical Leave of Absence

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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

Here's how to ask for a leave of absence from your job:Understand your legal rights regarding time off and pay.Make the request in person.Give sufficient advance notice.If possible, work with your boss to develop an agreeable plan.Keep track of relevant paperwork.

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

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.

Growth Trends for Related Jobs If you're covered by the law, you aren't required to ask a doctor for a written excuse before requesting time off. However your employer is within its rights to ask for a doctor's certification, which confirms that you have legitimate FMLA reasons for your absence.

Some common reasons employees take a leave of absence are to recover from a serious illness, undergo a medical procedure, assist a family member, take an extended trip or welcome a new child into the family.

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.

Sample LetterSmith, 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.

To take FMLA leave, you must provide your employer with appropriate notice. If you know in advance that you will need FMLA leave (for example, if you are planning to have surgery or you are pregnant), you must give your employer at least 30 days advance notice.

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.

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.

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West Virginia Application for Family Medical Leave of Absence