DoL WH-381 2009 free printable template

Notice of Eligibility and Rights Responsibilities Family and Medical Leave Act U.S. Department of Labor Employment Standards Administration Wage and Hour Division OMB Control Number 1215-0181 Expires 12/31/2011 In general to be eligible an employee must have worked for an employer for at least 12 months have worked at least 1 250 hours in the 12 months preceding the leave and work at a site with at least 50 employees within 75 miles. While use of...

How to fill out DoL WH-381

How to fill out DoL WH-381

1. Obtain the DoL WH-381 form from the Department of Labor website or your employer.
2. Fill in your personal information at the top, including your name, address, and contact details.
3. Indicate the reason for your leave of absence by checking the appropriate box.
4. Provide details regarding the date you need the leave to start and expected return date.
5. Include any necessary medical certification or documentation as requested.
6. Sign and date the form to certify that the information provided is accurate.

Who needs DoL WH-381?

1. Employees who are requesting leave under the Family and Medical Leave Act (FMLA) for a serious health condition, to care for a family member, or for the birth and care of a newborn child.

Instructions and Help about DoL WH-381

Welcome to module 2 in this module we're reviewing the forms provided by the Department of Labor for family medical leave situations this form entitled notice of eligibility and rights and responsibilities is the form that a supervisor completes when an employee indicates that he or she needs to take Family Medical Leave let's go ahead and walk through the form when an employee says that he or she is taking a leave you want to first off complete Part A to indicate whether the employee is eligible for leave you're going to of course list the employee's name and your name as the supervisor and the date that the form is being completed you're going to indicate here the date that you were informed that the employee needed to take leave and the date that the leave is to begin and then the various reasons for the leave are listed here, so you're going to check off whichever one applies if it's due to the employees in serious health condition the birth of a child etc the notice is to inform you that, and it says are eligible for Family Medical Leave are not eligible for Family Medical Leave this section is vital for the supervisor to complete correctly so please contact human resources for any guidance if you're not sure if an employee is eligible or not for family medical leave the employer is required by law to inform the employee whether he or she is eligible for Family Medical Leave, so it is very important that we get this form to the employee in a timely fashion it indicates down here that if you have any questions contact feel free to list Molly fern or Regina McCarty whichever employee relations manager handles your vicariate we're happy to handle any questions an employee has about Family Medical Leave it also says or view the Family Medical Leave poster located in your labor law posters have a section about Family Medical Leave so if you have that poster in your lounge you certainly can indicate that also Part B of the form is the rights and responsibilities section it states here in order for us to determine whether your absence qualifies as Family Medical Leave you must return the following information to us by so we're asking the employee to return the health care provider form back to us within the 15 calendar days so that's why it indicates here that a dates needed so the employee has a deadline so normally you're going to give this form to the employee along with giving them the form 380 II or a 380 F depending on the reason for the leave then it states here sufficient certification to support your request for Family Medical Leave a certification form that sets forth the information necessary to support your request is or is not enclosed, so we normally are going to enclose that form WH 380 or F for the employee to take to his or her doctor or family members doctor to get that sufficient certification for Family Medical Leave there's also invocation here other information is needed such as documentation for military family leave if an...

People Also Ask about

What is an example of a leave request for FMLA?

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.

What is an example of a letter requesting for leave?

I would like to inform you that the reason for my request is (explain the reason to justify your time off from work, making sure it is covered by your employer's leave of absence policy. For instance, the reason might be a family member's wedding, medical emergency, jury duty, etc).

What is the longest you can take FMLA?

The Family and Medical Leave Act (FMLA) provides certain employees with up to 12 weeks of unpaid, job-protected leave per year. It also requires that their group health benefits be maintained during the leave.

How do you tell your boss you're taking FMLA?

When you talk to your employer: Provide enough information to indicate that your leave is due to an FMLA-qualifying reason. While you do not have to specifically ask for FMLA leave, you do need to provide enough information so your employer is aware it may be covered by the FMLA.

What is an example of a FMLA request?

I require a leave of absence from [Start Date] to [End Date] . because: I am temporarily unable to work because of my own serious health condition. I will be caring for a family member (spouse, child, or parent) with a serious health condition.

Can a therapist write a letter for FMLA?

The federal FMLA form allows master's level therapists to sign off on FMLA. The catch is some companies do not think it's allowed so they ask for a doctor's signature.

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What is DoL WH-381?

DoL WH-381 is a form used to request leave under the Family and Medical Leave Act (FMLA), specifically for qualifying exigencies related to a family member's military service.

Who is required to file DoL WH-381?

Employees who are eligible for FMLA leave due to a qualifying exigency arising from a family member's military service are required to file DoL WH-381.

How to fill out DoL WH-381?

To fill out DoL WH-381, employees must provide their personal information, details about the qualifying exigency, and any required supporting documentation as specified in the form's instructions.

What is the purpose of DoL WH-381?

The purpose of DoL WH-381 is to enable eligible employees to formally request leave related to specific situations that arise when a family member is called to active duty or is in active service.

What information must be reported on DoL WH-381?

The information that must be reported on DoL WH-381 includes the employee's name, contact information, details of the family member's military service, the nature of the qualifying exigency, and the dates for which leave is requested.