FMLA Form Louisiana

This form is not mandated by the State of Louisiana. ***Employees of congregate settings (nursing homes, prisons) should refer to CDC setting-specific guidance for when to return to work. ****The test must be a negative PCR/molecular test at least five days after exposure to a positive case or suspected illness. Return-to-Work Self-Certification for COVID-19* Persons with …

Grievance Forms. Conditional Offer of Employment. Request to Recruit for a Vacant Position. Section Induction Checklist. Release for Reference Checking. State of Louisiana Employment Application (SF-10) Application for Student Employment (SF-10D) Application to Employ Minors Under Age 18. Special Leave Request.

Forms. BHI has several methods with which to request custom data not otherwise available on our site. To request aggregate or de-identified public health data, please complete our Online Data Request Form.. If you are an employee of DHH or a DHH contractor and are requesting access to a public health database, please complete and sign the Interoffice Request for …

This form is to be completed by the employee’s supervisor upon receipt of a leave request that may be FMLA-related or upon the fourth day of an absence of more than 3 consecutive days. Please submit completed form to Human Resources. Employee Name: Personnel #: Supervisor Name: Time Administrator Name/Phone #: Supervisor Phone#: Office: FMLA qualifying event: …

University of Louisiana at Lafayette Office of Human Resources Physical Address: 104 University Circle, Lafayette, LA 70503 Martin Hall, Room 170 Mailing Address: PO Box 40196, Lafayette, LA 70504 (337) 482-6242 | humanresources@louisiana.edu

PLEASE SUBMIT COMPLETED FMLA EMPLOYEE REQUEST FORM TO HUMAN RESOURCES HR Use Only: FMLA Quota Entered _____By_____ (Date) (Signature of HR Professional) LOUISIANA DEPARTMENT OF HEALTH . Author: nfleming1 Created Date: 5/14/2018 1:40:37 PM …

*Eligible employee: an employee who has been employed by the State of Louisiana for at least twelve (12) months, and has performed at least 1,250 hours of service during the 12-month period immediately preceding the commencement of the leave. (Annual, sick or compensatory leave taken shall not be applicable for meeting this 1,250 hour requirement. Compensatory time …

Louisiana Department of Health (LDH) EMPLOYEE INSTRUCTIONS and REQUEST FORM FOR LEAVE UNDER THE FAMILIES FIRST CORONAVIRUS RESPONSE ACT (FFCRA) (April 01, 2020 – March 31, 2021) EXCLUSION: The FFCRA provides that health care providers and emergency responders may be excluded from the Act’s provisions. Effective September 16, …

giving this form to your employee. Your response is voluntary. While you are not required to use this form, you may not ask the employee to provide more information than allowed under the FMLA regulations, 29 C.F.R. §§ 825.306-825.308. Employers must generally maintain records and documents relating to medical certifications, recertifications, or medical histories of …