Form 9611 (Rev 6-2014) Application for Leave Under the Family and Medical Leave Act-2025

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The document is an application form for requesting leave under the Family and Medical Leave Act (FMLA). It includes sections for personal information, type of leave requested (regular, military-related exigency, or military family FMLA), reasons for the request, anticipated leave dates, and necessary certifications. The form also allows for manager approval and outlines potential reasons for disapproval.

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2014	4.1 Satisfied (40 Votes)
1997	4.8 Satisfied (251 Votes)

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What are the rules for FMLA in California?

In order to be eligible to take leave under the FMLA, an employee must (1) work for a covered employer, (2) work 1,250 hours during the 12 months prior to the start of leave, (3) work at a location where 50 or more employees work at that location or within 75 miles of it, and (4) have worked for the employer for 12

What is the Family Medical Leave Act in California?

The FMLA/CFRA entitles eligible employees up to twelve (12) workweeks of unpaid, job-protected leave each calendar year (January 1st December 31st) for specified family and medical reasons.

Who is eligible for the family leave Act in California?

To take the leave, you must have recently had a child, have a serious health condition, or be taking care of a family member with a serious health condition.

fmla employee

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Do you get paid on FMLA in CA?

In reality, while FMLA leave is unpaid, the employer must maintain the employees health benefits under the same conditions as if they were working. Other benefits, such as seniority or paid leave accrual, may not necessarily continue to accrue during the period of FMLA leave.

What is an example of a FMLA request?

Please be advised that I hereby request an FMLA leave for a period of (number of weeks) in connection with my serious health condition. The leave is to start on (date). Attached is my medical note reflecting the need for FMLA leave. Please let me know whether you approve this leave at your earliest convenience.

What are the rules around FMLA?

Employees are eligible for leave if they have worked for their employer at least 12 months, at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles.

What is the Family Medical Leave Act in NY?

FMLA Overview The Family Medical Leave Act provides eligible employees up to 12 weeks of unpaid, job-protected leave a year whether you are unable to work because of your own serious health condition or because you need to care for a family member with a serious health condition.

Does anxiety qualify for FMLA?

For Self: An employee can take FMLA time if they have a serious health condition that severely impacts their ability to work. Some common conditions that may qualify include depression and severe anxiety. For Family Members: An employee can take FMLA leave to provide care for their spouse, parent, or child.

Form 9611 (Rev 6-2014) Application for Leave Under the Family and Medical Leave Act-2025

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Can I complete and sign my [KEY] online?

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What are the rules for FMLA in California?

What is the Family Medical Leave Act in California?

Who is eligible for the family leave Act in California?

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Do you get paid on FMLA in CA?

What is an example of a FMLA request?

What are the rules around FMLA?

What is the Family Medical Leave Act in NY?

Does anxiety qualify for FMLA?

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