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.
The Chicago Illinois Employee Application for FMLA is the official form provided by the City of Chicago for employees to apply for Family and Medical Leave Act (FMLA) benefits. This comprehensive application ensures that eligible employees in Chicago can request and obtain job-protected leave for qualifying family and medical reasons. The application form requires employees to provide detailed information about themselves, their employer, and their situation. It includes several sections that cover various aspects necessary for the application process. Some relevant keywords that may be included in the application form and its instructions are: 1. Eligibility: The form will require employees to determine their eligibility for FMLA benefits by meeting certain criteria such as working for a covered employer and having worked a specified number of hours within the previous year. 2. Covered Employers: The application would identify which employers in Chicago are subject to providing FMLA benefits, including private sector employers with 50 or more employees and public agencies. 3. Qualifying Reasons: The form will outline the various reasons an employee can take FMLA leave, including the birth or adoption of a child, caring for a close family member with a serious health condition, or the employee's own serious health condition. 4. Certification: Employees will need to provide medical certification from qualified healthcare providers, supporting their need for FMLA leave based on their or their family member's health condition. The form may include sections specifying the required information and format for these certifications. 5. Intermittent Leave: If an employee's condition requires intermittent leave, the application form may include sections specifically addressing this type of leave, including the frequency and duration of the needed absences. 6. Employee Protections: The application form or instructions may highlight the protections afforded to employees taking FMLA leave, such as maintaining health benefits during leave and being restored to the same or equivalent position upon return. It's important to note that while the content described above is relevant to the general FMLA application in Chicago, specific form names or versions may vary. It is recommended to check the official City of Chicago's website or the employee handbook for precise information on the application form, as it may be updated periodically to align with federal and local regulations.
