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FMLA LEAVE OF ABSENCE FORM Part A. Employee Information Employee's Name: Employee ID # (Last) (First) (MI) Address: Position Title: SHE STC Part B. Leave Dates (Continuous or Intermittent) Estimated

How to fill out fmla leave of absence

How to Fill Out FMLA Leave of Absence:

1. Get the necessary forms: Obtain the FMLA certification forms from your employer's HR department or download them from the official website of the Department of Labor.
2. Familiarize yourself with the eligibility criteria: Make sure you meet the requirements for taking FMLA leave. Generally, you must have worked for the employer for at least 12 months and have accumulated 1,250 hours of work within the past year.
3. Complete the employee information section: Provide your contact details, including your name, address, phone number, and employee identification number if applicable.
4. Specify the reason for taking FMLA leave: Indicate the medical condition that qualifies you for this type of leave, whether it's for your own serious health condition or that of a family member.
5. Attach medical certification: Ask your healthcare provider to complete the certification form by providing the necessary medical information and stating the expected duration of the leave. Ensure the healthcare provider signs and dates the form.
6. Indicate the start and end dates of the leave: Clearly state the first day you intend to take leave and the anticipated return date. If the duration is uncertain, mention that you will provide notice as soon as possible.
7. Sign and date the form: Once you have completed all the relevant sections, sign and date the FMLA leave of absence form. This signature affirms that the information provided is accurate to the best of your knowledge.
8. Submit the form to your employer: After filling out the form, submit it to your employer's HR department within the designated timeline or as instructed by your employer's FMLA policy.

Who Needs FMLA Leave of Absence:

1. Employees with serious health conditions: Individuals who are suffering from a serious health condition that makes them unable to perform their job responsibilities may be eligible for FMLA leave of absence. This could include conditions such as cancer, chronic illnesses, or physical or mental impairments that require treatment or ongoing care.
2. Employees with a qualifying family member's health condition: FMLA also grants leave to employees who need to care for an immediate family member with a serious health condition. Immediate family members typically include a spouse, child, or parent.
3. Employees welcoming a new child: FMLA provides leave for the birth or adoption of a child. Both mothers and fathers are eligible to take FMLA leave for bonding with their new child or to address any related medical conditions.

Overall, FMLA leave of absence is designed to protect employees who require time off for medical reasons or to address family-related needs. Understanding the process and eligibility criteria for taking such leave can help ensure a smooth and successful application.

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