FMLA Request Form

Introduction

The Family Medical Leave Act (FMLA) Form is to be used if there is going to be a consecutive absence of more than five days or if intermittent time off is needed. Upon completion of the form, further instruction will be given regarding the certification of medical need.

Details

Please consult the following policies for more information:

Family and Medical Leave

Parental Leave

Flexible Work Arrangements

 
FMLA Leave Request

Details

Service ID: 51840
Created
Tue 4/19/22 1:09 PM
Modified
Thu 6/2/22 2:06 PM