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Family and Medical Leave Request 1 - University System of Georgia

Family and Medical Leave Request 1 - University System of Georgia 2025

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The document is a Family and Medical Leave Request form for employees under the Family and Medical Leave Act (FMLA). It outlines the eligibility criteria, reasons for requesting leave, and the process for submitting the request. Employees must provide personal information, details about their employment history, and the reason for their leave. The form also includes sections for supervisor approval and documentation of previous leave requests.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the date, your name, and Social Security Number at the top of the form. This information is essential for identification purposes.
Fill in your supervisor or department head's name and your job title. This helps ensure that your request reaches the appropriate person.
Answer the eligibility questions regarding your employment duration and hours worked. If you answer 'no' to any question, follow the instructions provided.
Indicate the reasons for requesting leave by checking the appropriate boxes. Be specific about whether it's for personal health, family care, or other qualifying reasons.
Specify the dates of leave requested and any intermittent or reduced schedule requests if applicable.
Sign and date the form at the bottom, confirming your agreement to return to work as stated.

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What conditions qualify for FMLA leave in Georgia?

An eligible employee may take FMLA leave because of his or her own serious health condition or to care for a qualifying family member with a serious health condition that resulted from domestic violence.

Can I use FMLA for college?

Using FMLA does not directly affect a students right to attend school. If the question concerns an employee attending school while on FMLA leave, the key is that FMLA protects job status during approved leave periods. Eligibility requires working for a covered employer and meeting hours worked criteria.

What medical conditions qualify for FMLA leave?

TYPES OF SERIOUS HEALTH CONDITIONS. The FMLA defines a serious health condition as an illness, injury, impairment, or physical or mental condition that involves either inpatient care or continuing treatment by a health care provider. Both physical and mental health conditions qualify for FMLA leave.

What qualifies you for FMLA in GA?

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 are the two categories of reasons for leave that are covered by the FMLA?

The FMLA provides eligible employees of covered employers with job-protected leave for qualifying family and medical reasons and requires continuation of their group health benefits under the same conditions as if they had not taken leave.

What makes you not qualify for FMLA?

The employee hasnt worked at the company for long enough. However, they also have to work 1,250 hours within the past 12 months, which means some part-time or seasonal workers may not qualify.

What proof do you need for FMLA?

Certification forms. The FMLA does not require the use of any specific certification form. The Department has developed optional forms that can be used for leave for an employees own serious health condition (WH-380-E) or to care for a family members serious health condition (WH-380-F).

Family and Medical Leave Request 1 - University System of Georgia 2025

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How to use or fill out Family and Medical Leave Request 1 - University System of Georgia with DocHub

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Got questions?

What conditions qualify for FMLA leave in Georgia?

Can I use FMLA for college?

What medical conditions qualify for FMLA leave?

What qualifies you for FMLA in GA?

What are the two categories of reasons for leave that are covered by the FMLA?

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What makes you not qualify for FMLA?

What proof do you need for FMLA?

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Family and Medical Leave Request 1 - University System of Georgia 2025

Here's how it works

How to use or fill out Family and Medical Leave Request 1 - University System of Georgia with DocHub

Complete this form in 5 minutes or less

Got questions?

What conditions qualify for FMLA leave in Georgia?

Can I use FMLA for college?

What medical conditions qualify for FMLA leave?

What qualifies you for FMLA in GA?

What are the two categories of reasons for leave that are covered by the FMLA?

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People also ask

What makes you not qualify for FMLA?

What proof do you need for FMLA?

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