Get the free Family Medical Leave Form - University of Central Arkansas - uca
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FAMILY MEDICAL LEAVE
(March 2009)
Family Medical Leave (FM) provides eligible employees with up to twelve (12) workweeks of
leave time during a rolling twelve (12) month period. The rolling (12) month
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How to fill out family medical leave form
How to fill out a family medical leave form:
01
Start by carefully reading the instructions provided on the form. Familiarize yourself with the purpose of the form and the information required.
02
Begin by filling out your personal information, including your name, address, phone number, and employee ID number.
03
Indicate the specific reason for taking family medical leave. Common reasons include caring for a newborn or newly adopted child, caring for a family member with a serious health condition, or tending to your own serious health condition.
04
Provide details about the anticipated start and end dates of your leave. This may include the date you intend to start your leave and when you expect to return to work. If the duration is uncertain, explain the reasons for the uncertainty.
05
Specify whether you plan to take the leave consecutively or intermittently. Consecutive leave refers to taking all the time off at once, while intermittent leave allows for periodic absences.
06
If your leave is due to a family member's health condition, provide relevant information about their relationship to you and details about the medical condition itself. This may entail the name of the family member, their relationship to you, and a brief description of their condition.
07
If applicable, indicate any modifications needed to your work schedule or duties during the leave. This could include reduced hours, flexible work arrangements, or changes in responsibilities.
08
Ensure you sign and date the form alongside any other required authorization or consent sections.
Who needs a family medical leave form:
01
Employees who are eligible for and intend to take family medical leave from their employment.
02
Employees who are planning to take time off to care for a newborn or newly adopted child, tend to a family member with a serious health condition, or address their own serious health condition.
03
Employers who require documentation of an employee's intent to take family medical leave in order to ensure compliance with applicable laws and policies.
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