Maine Family and Medical Leave of Absence Request Form
Author: Katherine Hinde, Littler
When to Use
A covered employer in Maine can use this form to receive employee requests for a family and medical leave of absence covered by the federal Family and Medical Leave Act (FMLA) and/or the Maine Family and Medical Leave Act (MFMLA).
Employer coverage under these laws is as follows:
- The FMLA covers employers that employ 50 or more employees in 20 or more workweeks in the current or preceding calendar year and that are engaged in commerce or in any industry or activity affecting commerce.
- The MFMLA covers employers in Maine with 15 or more employees at one location in the state.
Customizable Form
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