This form is an application for Family and Medical Leave. It is to be filled out by an employee who is requesting a leave of absence.
Fmla Application Forms For Usps Employees
State:
Multi-State
Control #:
US-AHI-200
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Word
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Under the family and medical leave act of 1993 (FMLA), eligible employees of the U.S. Postal Service are entitled to receive unpaid leave for qualified medical and family reasons. Qualified medical and family reasons include: personal or family illness, pregnancy, adoption, or the foster-care placement of a child.
514.5 Forms RequiredA request for LWOP is submitted by the employee on PS Form 3971. If the request for leave indicates that the LWOP will extend over 30 days, a written justification and statement of reason for the desired absence is required.
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.
U.S. Postal Service employees wishing to exercise rights under the FMLA may do so by submitting online form PS 3971, Request for or Notification of Absence. This form is prepared the same as any other annual or sick leave request. Advance notification is preferred by the USPS, with 30 days advance notice ideal.
U.S. Postal Service employees wishing to exercise rights under the FMLA may do so by submitting online form PS 3971, Request for or Notification of Absence. This form is prepared the same as any other annual or sick leave request. Advance notification is preferred by the USPS, with 30 days advance notice ideal.
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FMLA Form WH-380-E for Employee Health Condition — FMLA Form WH-380-E for Employee Health Condition. FMLA is a federal law that entitles eligible employees to take jobprotected leave to attend to certain serious health and family matters.FMLA-covered condition. NALC Form 1 - Family and Medical Leave Act of 1993. Medical Leave of Absence Request and Notice Form. The Medical Leave Request Form must be completed and delivered to the employee's supervisor for departmental signatures.