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Versions Form popularity Fillable & printable
DoL WH-380-F 2020 4.8 Satisfied (108 Votes)
DoL WH-380-F 2015 4.3 Satisfied (50 Votes)
DoL WH-380-F 2009 4.4 Satisfied (357 Votes)
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This form, like 380-E, requires the employer, employee, and health care practitioner to complete specific information. Your relative's medical provider must complete the rest of the form with information similar to that required by Form 380-E, such as: When the condition began.
Employees in Texas may take up to 12 weeks of leave in a 12-month period for a serious health condition, bonding with a new child, or qualifying exigencies. This leave renews every 12 months, as long as the employee continues to meet the eligibility requirements set out above.
Key employees are those who are paid on a salary basis and are among the highest paid 10 percent of the organization's employees who work within 75 miles of the particular employee's worksite.
To apply for leave under FMLA, contact the personnel office of your employer agency. If eligible and approved, the personnel office will provide to the Fund's administrative office the appropriate information for continuation of Fund benefits.
The Family and Medical Leave Act (FMLA) provides certain employees with up to 12 weeks of unpaid, job-protected leave per year.
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Spanish Forms. Use this form to give employees notice of their rights under the California Family Rights Act (CFRA), and to designate leave as CFRA and/or Family and Medical Leave Act (FMLA), to provide conditional approval of the request for leave if more information is necessary or to deny the request.
Doctors aren't the only health care providers who may certify FMLA leave. Podiatrists, dentists, clinical psychologists, optometrists and chiropractors can all certify leave, as can nurse practitioners, nurse-midwives, clinical social workers and physician assistants.
How Do I Request FMLA Leave? To take FMLA leave, you must provide your employer with appropriate notice. If you know in advance that you will need FMLA leave (for example, if you are planning to have surgery or you are pregnant), you must give your employer at least 30 days advance notice.
Qualifying reasons for which an employee can take FMLA or PFML leave include: Birth, adoption, or placement of a foster child. For a serious health condition that makes the employee unable to perform the essential functions of their job. To care for a family member with a serious health condition.
Create My Document. Form WH 380-E, Certification of Health Care Provider for Employee's Serious Health Condition, is a form used by employers and sent to the US Department of Labor, Wages and Hour Division. This form verifies that an employee has a serious medical condition.

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