Get the free FML Certification Form - Employee Own Illness 01-12 .doc
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Family Medical Leave Act (FMLA) Certification for Employee s Serious Health Condition1 Return completed form to: Aetna Life Insurance Company PO Box 14560 Lexington, KY 40512-4560 Fax: 866-667-1987
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How to fill out fml certification form
How to fill out FML certification form:
01
Start by obtaining the FML certification form from your employer or the Human Resources department. It may also be available online on official government websites.
02
Read through the form carefully and ensure you understand each section and the information required.
03
Fill out your personal information accurately, such as your name, address, social security number, and contact details.
04
Provide details about your employer, including their name, address, and contact information.
05
Specify the reason for your leave, whether it’s for your own serious health condition, caring for a family member, or bonding with a newborn child.
06
Mention the start and end dates of your leave, indicating the total number of days.
07
If your leave is intermittent, meaning you will be taking it in separate periods instead of continuous, provide specific dates and durations for each period.
08
Attach any necessary supporting documentation, such as medical reports or a birth certificate, to validate your reason for leave.
09
Review the completed form to ensure all information is accurate and complete.
10
Sign and date the form.
11
Submit the filled-out FML certification form to your employer or the designated department.
Who needs FML certification form:
01
Employees who require leave under the Family and Medical Leave Act (FMLA) typically need to fill out the FML certification form.
02
Employees eligible for FMLA leave include those who need time off for their own serious health condition, to care for a family member with a serious health condition, or to bond with a newborn, adopted, or foster child.
03
It is important to check with your employer or HR department to confirm if you are eligible for FMLA leave and whether you need to fill out the FML certification form.
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What is fml certification form?
FML certification form is a document used by employees to request leave under the Family and Medical Leave Act.
Who is required to file fml certification form?
Employees who need to take leave under the Family and Medical Leave Act are required to file FML certification form.
How to fill out fml certification form?
To fill out FML certification form, employees must provide information about their medical condition, the duration of the leave requested, and any supporting documentation.
What is the purpose of fml certification form?
The purpose of FML certification form is to provide documentation of the need for leave under the Family and Medical Leave Act.
What information must be reported on fml certification form?
FML certification form must include information about the employee's medical condition, the duration of the leave requested, and any supporting documentation.
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