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State of Wisconsin Office of State Employment Relations Division of Compensation and Labor Relations FAMILY AND MEDICAL LEAVE EMPLOYEE REQUEST SECTION 1: For completion by the EMPLOYEE Name: Employee

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How to fill out family and medical leave

How to fill out family and medical leave:

01

Determine eligibility: Before filling out the paperwork, ensure that you meet the requirements for family and medical leave. Generally, you must have worked for a covered employer for at least 12 months and have completed 1,250 hours of service during the previous 12 months. Additionally, make sure the reason for leave qualifies under the Family and Medical Leave Act (FMLA), such as the birth or adoption of a child, caring for a seriously ill family member, or your own serious health condition.

02

Obtain the necessary forms: Contact your employer's human resources department or access the required forms online. Most employers provide a designated form for requesting family and medical leave. If not, a generic FMLA leave form can be used.

03

Fill out employee information: Begin by providing your personal details, such as your name, employee ID or Social Security number, contact information, and job title. Ensure the information is accurate and up to date.

04

Specify the type of leave: Indicate the reason for your leave request and detail the circumstances surrounding it. Be clear and concise to help the employer understand your situation and the purpose of your leave.

05

Specify the duration: Clearly state the start and end dates for your requested leave. If the timeframe is uncertain, provide an estimated duration and update your employer as necessary.

06

Include medical certifications: If your leave involves a serious health condition, include the appropriate medical certification from a healthcare provider. The certification must provide sufficient information regarding your condition and the need for medical leave.

07

Acknowledge the legal requirements: At the end of the form, sign and date it to confirm that the information provided is accurate to the best of your knowledge. By signing, you acknowledge that you understand the legal obligations and requirements associated with family and medical leave.

Who needs family and medical leave?

01

Employees expecting or caring for a newborn or newly adopted child.

02

Individuals caring for a seriously ill family member (such as a parent, spouse, or child).

03

Employees with a serious health condition that affects their ability to perform work duties.

04

Military families dealing with service member deployments or related issues.

Family and medical leave is available to eligible employees to provide them with job-protected time off for specific qualifying reasons. The leave not only enables individuals to attend to their personal and family needs but also ensures continuity of employment upon their return.

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What is family and medical leave?

Family and Medical Leave Act (FMLA) is a federal law that allows eligible employees to take unpaid, job-protected 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 under FMLA.

How to fill out family and medical leave?

Employees can request FMLA leave by submitting a request form to their employer along with any necessary supporting documentation.

What is the purpose of family and medical leave?

The purpose of FMLA is to help employees balance work and family responsibilities by providing protected leave for qualifying events.

What information must be reported on family and medical leave?

Employees must provide information about the reason for their leave and the expected duration of their absence.

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