Leave Application Form WH-380-E and WH-380-F

Employee’s serious health condition, form WH-380-E

A Leave Application Form is a document used by employers to grant an employee permission to take time off from work. The form typically includes information such as the employee's name, job title, the duration of the leave, the reason for the leave, and the employee's contact information. Depending on the employer, the form may also include additional information such as the supervisor's signature, the employee's signature, and other relevant documents. The form may also include a section for the employee to provide additional information or documents that may be required for the leave.

Examples of Leave Application Forms include the

  • U.S. Department of Labor's Family and Medical Leave Act (FMLA) form,
  • U.S. Department of State's Leave Request Form, 
  • U.S. Department of Defense's Leave Request Form.

The U.S. Department of Labor's Family and Medical Leave Act (FMLA) form is used by employers to grant an employee up to 12 weeks of unpaid, job-protected leave in a 12-month period for certain family and medical reasons. The form must be completed by the employee, the employer, and the employee's health care provider. The form requires the employee to provide information about their job title, the duration of the leave, the reason for the leave, and the employee's contact information. It also requires the employer to provide information such as the name of the employee's supervisor, the dates of the leave, and the nature of the leave.

The form also requires the employee's health care provider to provide information such as the diagnosis, prognosis, and treatment plan. Once the form is completed, the employer must provide the employee with a copy of the form, and the employee must sign the form to acknowledge that they have received it. The form must then be submitted to the U.S. Department of Labor for approval.

Submitting the U.S. Department of Labor's Family and Medical Leave Act (FMLA) form provides a number of benefits to the employee. First, it grants the employee up to 12 weeks of unpaid, job-protected leave in a 12-month period for certain family and medical reasons. This means that the employee will be able to take time off from work without fear of losing their job. Additionally, the employee will be able to maintain their health insurance coverage during the leave, as long as they continue to pay their share of the premiums.

Finally, the employee will also be able to take advantage of any other benefits they are eligible for, such as vacation and sick leave, during the leave period.

Form WH-380-E is used when an employee is requesting leave due to their own serious health condition. This form must be completed by the employee and their health care provider, and it requires the employee to provide information such as their name, job title, the duration of the leave, the reason for the leave, and the employee's contact information. It also requires the employee's health care provider to provide information such as the diagnosis, prognosis, and treatment plan.

Form WH-380-F is used when an employee is requesting leave due to the serious health condition of a family member. This form must be completed by the employee, the family member's health care provider, and the family member's employer (if applicable). It requires the employee to provide information such as the family member's name, job title, the duration of the leave, the reason for the leave, and the family member's contact information. It also requires the family member's health care provider to provide information such as the diagnosis, prognosis, and treatment plan. The family member's employer must also provide information such as the family member's job title and dates of employment. Once the form is completed, the employee must submit the form to the U.S. Department of Labor for approval.

 

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