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.
Harris Texas Employee Application for FMLA
State:
Multi-State
County:
Harris
Control #:
US-AHI-200
Format:
Word
Instant download
Description
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How to fill out Employee Application For FMLA?
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FAQ
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
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.
Although FMLA leave is unpaid, employees may be allowed (or required) to use their accrued paid leave during FMLA leave. When an employee's FMLA leave ends, the employee is entitled to be reinstated to the same or an equivalent position, with a few exceptions.
The Family and Medical Leave Act (FMLA) provides eligible employees up to 12 workweeks of unpaid leave a year, and requires group health benefits to be maintained during the leave as if employees continued to work instead of taking leave.
How Do You Request Medical Leave in South Carolina? An employee isn't required to do anything formal to take medical leave under the FMLA. An employee only needs to notify his or her employer that they need time off for medical reasons.
Section 101(11) of FMLA defines serious health condition as "an illness, injury, impairment, or physical or mental condition that involves: inpatient care in a hospital, hospice, or residential medical care facility; or. continuing treatment by a health care provider.
FMLA certification is a medical confirmation that is generally required for employees to take leave per the Family Medical Leave Act. Generally, this is required in the case of employees or their direct family members sustaining a serious health condition that requires time off work for caregiving or recuperation.
You may take FMLA leave to care for your spouse, child or parent who has a serious health condition, or when you are unable to work because of your own serious health condition. 4) pregnancy (including prenatal medical appointments, incapacity due to morning sickness, and medically required bed rest).
To apply for a medical leave of absence: Submit your application: Online, or. Print, complete and fax an Application for Leave of Absence. Have your treating physician complete one of the following: FMLA Certification of a Serious Health Condition, or. Non-FMLA Medical Certification. Not sure if you qualify under the FMLA?
