Miami-Dade County, Florida, Family and Medical Leave of Absence Request Form

Author: Susie Wine, Littler

When to Use

A covered Miami-Dade County, Florida, employer 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 Miami-Dade County family and medical leave law.

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 Miami-Dade County family and medical leave law applies to any employer that in the regular course of business has 50 or more employees working in Miami-Dade County for each working day during each of the 20 or more calendar workweeks in the current or preceding calendar year.

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