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It outlines the specific eligibility criteria for unpaid leave, including childbirth, adoption, placement for foster care, caring for family members with serious health conditions, or personal incapacity to perform job duties. The form requires detailed information regarding the employee, requested leave duration, and medical documentation from a physician. Additionally, it addresses requirements for a thirty-day notice period, the use of accrued sick leave, and the continuation of group insurance benefits during the approved leave period, ensuring that employees understand both their obligations and the protections afforded under federal guidelines.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/hobbs-municipal-schools-family-and-medical-leave-act-employee-application-for-benefits/306708/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/hobbs-municipal-schools-family-and-medical-leave-act-employee-application-for-benefits/306708.png","ImageObject",442,249,{"name":88,"@type":89},"Mia  ","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-22","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":15},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the maximum duration for the requested unpaid leave?","Question",{"text":108,"@type":109},"The maximum duration for FMLA leave is 12 weeks, which is equivalent to 60 calendar days.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Is advance notice required for taking leave?",{"text":113,"@type":109},"Yes, a thirty-day notice is required unless the need for leave is considered unforeseeable.",{"name":115,"@type":106,"acceptedAnswer":116},"Can an employee continue group insurance coverage during leave?",{"text":117,"@type":109},"Yes, employees may continue to participate in group insurance plans provided they continue to pay their share of the premiums.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},306708,1790215771,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":15,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":4},687207024478,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","HOBBS MUNICIPAL SCHOOLS FAMILY AND MEDICAL LEAVE ACT EMPLOYEE APPLICATION FOR BENEFITS  \nNAME:   SCHOOL CAMPUS:   POSITION:   SSN:    \nREASONS FOR TAKING LEAVE:  \nUnpaid leave must be granted for any of the following reasons:  \n• To care for the employee's child after birth, or placement for adoption or faster care;  \n• To care for the employee's spouse, son or daughter, or parent, who has a serious health condition;  \n• For a serious health condition that makes the employee unable to perform the employee's job and or duties.  \nThirty (30) day notice is REQUIRED unless leave is \"unforeseeable\"  \nAs an employee of the Hobbs Municipal Schools, I would like to apply for UNPAID Family & Medical Leave Benefits for   days (max of 12 weeks/60 calendar days) . Requirements must be met.  \nPhysician’s Name:   Address:   Phone:   Nature of Family/Medical Leave:  \nBeginning Date of Leave:   Anticipated Date to Return to Work:    \nWill use Available Sick Leave Days: YES NO  \nNumbers of Days: All  or    \nEmployee's Signature Date  \nApproved   Denied   \nAssistant Superintendent of Human Resources Date  \nFederal Family & Medical Leave Act: An employee on approved Federc1I Family and Medical Leave may continue to participate in all phases of the group insurance as long as the employee continues to pay his/her share of the premium. The Board will continue to pay their portion of the premium If the employee's portion is continued.","cbCaifefIzusuM7j","https://ap.wps.com/l/cbCaifefIzusuM7j","pdf",288659,"English","# Application Details\n## Leave Reasons and Eligibility\n## Leave Duration and Scheduling\n## Physician Information\n## Benefits and Insurance Coverage","[{\"question\":\"What is the maximum duration for the requested unpaid leave?\",\"answer\":\"The maximum duration for FMLA leave is 12 weeks, which is equivalent to 60 calendar days.\"},{\"question\":\"Is advance notice required for taking leave?\",\"answer\":\"Yes, a thirty-day notice is required unless the need for leave is considered unforeseeable.\"},{\"question\":\"Can an employee continue group insurance coverage during leave?\",\"answer\":\"Yes, employees may continue to participate in group insurance plans provided they continue to pay their share of the premiums.\"}]","Hobbs Municipal Schools - Family and Medical Leave Act - Employee Application for Benefits | PDF",1789840228]