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.
Colorado Employee Application for FMLA
State:
Multi-State
Control #:
US-AHI-200
Format:
Word
Instant download
Description
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How to fill out Employee Application For FMLA?
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FAQ
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.
Employees will be able to take paid leave for many of the same reasons permitted under the federal Family and Medical Leave Act (FMLA). The program also will extend paid leave so victims of domestic violence, sexual assault or stalking can handle related issues.
Qualifying for FMLABirth of a child and must be completed within one year of the birth.Placement and care of an adopted or foster child and must be completed within one year of the placement.Serious health condition of a parent, child, spouse, or self.Employee's own serious health condition.More items...
Qualifying for FMLA FML and state family medical leave is granted for: Birth of a child and must be completed within one year of the birth. Placement and care of an adopted or foster child and must be completed within one year of the placement. Serious health condition of a parent, child, spouse, or self.
EligibilityHave worked for your employer for at least 12 months; and.Have worked for your employer for at least 1,250 hours in the 12 months before you are taking leave; and.Work at a location where your employer has at least 50 employees within 75 miles of your worksite.
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
To apply for FMLA, the employee must take an FMLA Medical Certification Form to their health care provider. This form ensures that the employee's or family member's applicable health condition is valid. After receiving the form, the employee must return it within 15 calendar days.
The FAMLI program will ensure all Colorado workers have access to paid leave in order to take care of themselves or their family during life circumstances that pull them away from their jobs like growing their family or taking care of a loved one with a serious health condition.
Covered individuals will receive paid leave amounting to:90% of their average weekly wage for the portion of their wages equal to or less than 50% of the state average weekly wage; and.50% of the portion of their wages that exceeds the state average weekly wage.
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