Get the free FAMILY AND MEDICAL LEAVE ACT OF 1993 (FMLA)

EXTENDED LEAVE OF ABSENCE REQUEST FORM Name (Please print) Position/Assignment Building Type(s) of extended leave requested: check below Sick Leave (two weeks or more) Family Medical Leave (FMLA)

How to fill out family and medical leave

How to Fill Out Family and Medical Leave:

1. Gather necessary information: Before filling out the family and medical leave form, collect all the required information such as your personal details, including name, address, contact information, and employee identification number.
2. Understand eligibility criteria: Make sure you meet the eligibility requirements for family and medical leave. Generally, you must have been employed by the same employer for at least 12 months and have worked a minimum of 1,250 hours during that time.
3. Obtain the appropriate form: Contact your employer's Human Resources department or visit their website to obtain the family and medical leave form. It is usually called the FMLA Certification Form or something similar.
4. Complete employee section: Fill out the employee section of the form, providing accurate and detailed information about yourself, including your name, job title, department, and the dates you anticipate needing leave.
5. Provide medical certification: If you or a close family member have a serious health condition, you may need to get a healthcare provider to complete the medical certification section of the form. This certification verifies the need for leave and outlines the expected duration.
6. Include necessary documentation: Attach any supporting documentation required, such as medical records, examiner's notes, or any other relevant paperwork that supports your need for leave. Make sure to include copies and keep the originals for your records.
7. Submit the form: Once you have completed all the necessary sections and attached any required documentation, submit the family and medical leave form to your employer. Follow their preferred method of submission, whether it's online, through email, or by dropping off a hard copy.

Who Needs Family and Medical Leave:

1. Employees with serious health conditions: Family and medical leave is designed to provide job-protected leave for individuals who are dealing with their own serious health condition. It allows them to take the time off necessary for medical treatment, recovery, or managing chronic conditions.
2. Family members of those with serious health conditions: Family and medical leave also extends to employees who need to care for their spouse, child, or parent with a serious health condition. This provision ensures they can support and assist their loved ones during their medical journey.
3. Maternity and paternity leave: Family and medical leave can be utilized by expecting parents to bond with their newborn or newly adopted child. This time off is crucial for parents to establish necessary routines, provide care, and create a nurturing environment for the child's growth and development.
4. Military family leave: In cases where an employee's spouse, child, or parent is called to active duty or injured in military service, family and medical leave can be used to provide support and attend to family matters related to deployment or recovery.

Note: The specific eligibility and provisions of family and medical leave may vary depending on your location and the regulations set by your employer and applicable laws. It is always advised to consult your employer's HR department or refer to the official family and medical leave policies for accurate information.

For pdfFiller’s FAQs

What is family and medical leave?

Family and Medical Leave Act allows eligible employees to take unpaid leave for specified family and medical reasons.

Who is required to file family and medical leave?

Employers with 50 or more employees are required to provide family and medical leave.

How to fill out family and medical leave?

Employees can request the leave through their employer's HR department and fill out the necessary paperwork.

What is the purpose of family and medical leave?

The purpose of family and medical leave is to provide job-protected leave for personal or family medical reasons.

What information must be reported on family and medical leave?

Employees must report the reason for their leave and the expected duration of the leave.

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