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DoL WH-381 free printable template

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While use of this form by employers is optional a fully completed Form WH-381 provides employees with the information required by 29 C. Other information needed such as documentation for military family leave Page 1 No additional information requested CONTINUED ON NEXT PAGE Form WH-381 Revised February 2013 If your leave does qualify as FMLA leave you will have the following responsibilities while on FMLA leave only checked blanks apply Contact at to make arrangements to continue to make your...
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The WH-381 form is used by employers to pay wages to employees who have qualified for Family and Medical Leave (FMLA) protection. It is required to be completed by the employer when an employee takes FMLA leave.
According to the California Employment Development Department, employers face a penalty of up to $25 per employee per month, with a minimum of $100 and a maximum of $4,000, for failing to file the WH-381 form.
The WH-381 form is a Certification of Health Care Provider for Employee's Serious Health Condition under the Family and Medical Leave Act (FMLA). It is a document that employers may require employees to have completed by a healthcare provider in order to support their request for leave under the FMLA due to a serious health condition. The form provides important information about the employee's condition and the need for leave.
The purpose of the WH-381 form is to provide employees with information about their rights and responsibilities under the Family and Medical Leave Act (FMLA). This form explains the requirements for taking leave under FMLA, including the reasons for which leave can be taken, the medical certification process, continuation of health benefits during leave, and the employee's obligation to provide notice and return to work. The form also includes information on employee rights against discrimination or retaliation for taking FMLA leave.
The WH-381 form, also known as the Notice of Eligibility and Rights & Responsibilities form, is used in the United States to inform an employee about their rights under the Family and Medical Leave Act (FMLA). The information that must be reported on this form includes: 1. The employee's name and address 2. The employer's name and address 3. The employee's eligibility for FMLA leave, including whether they have worked for the employer for at least 12 months and have worked at least 1,250 hours in the past 12 months 4. The FMLA leave entitlement, specifically the total number of weeks of leave available to the employee 5. The employee's rights and responsibilities under the FMLA, including the requirement to provide sufficient notice of the need for leave, the use of paid leave during FMLA, and any obligations related to health insurance or benefits during the leave 6. The employer's expectations, including information on how the employee must request FMLA leave, contact information for the employer representative, and any certification requirements 7. Any additional information or requirements specific to the employer or the employee's situation It is important to note that the specific information required on the WH-381 form may vary slightly depending on the employer's policies and the employee's circumstances. Therefore, it is always recommended to consult the official form and guidelines provided by the U.S. Department of Labor for accurate and up-to-date information.
To fill out Form WH-381, you need to follow these steps: 1. Download the Form: Visit the official website of the Department of Labor (DOL) or find a reliable source to download the Form WH-381. Ensure you have the latest version of the form. 2. Provide General Information: Fill in the general information section at the top of the form. You need to enter the employer's name, address, phone number, and Employer Identification Number (EIN). Also, fill in the employee's name and identification details. 3. Leave Designation: In this section, indicate whether the leave requested is designated as qualifying military caregiver leave or qualifying exigency leave under the Family and Medical Leave Act (FMLA). 4. Qualifying Military Exigency Leave: If the leave requested is qualifying exigency leave under the FMLA, provide the requested details about the specific type of leave in this section. This may include details about deployment, rest and recuperation, childcare and school activities, financial and legal arrangements, and other considerations. 5. Qualifying Military Caregiver Leave: If the leave requested is qualifying military caregiver leave under the FMLA, provide the requested details about the specific type of leave in this section. This may include information about the covered servicemember, the need for care, the relationship between the employee and the servicemember, and other relevant details. 6. Employee's Signature: The employee must sign and date the form to certify the accuracy of the information provided. 7. Notice of Eligibility and Rights & Responsibilities: The notice section should be completed by the employer, providing information on the employee's eligibility for FMLA leave and the rights and responsibilities associated with taking such leave. 8. Designation Notice: The employer should complete this section to officially designate the leave as either qualifying military caregiver leave or qualifying exigency leave. Provide the requested details, including the expected duration of leave and any other important information related to the employee's leave. 9. Return to Employee: Provide the completed form to the employee, ensuring they receive a copy for their records. Remember to review the completed form for accuracy and ensure it is signed and dated by both the employee and the employer.
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