Get the free Family and Medical Leave (FMLA) Request Form - webs wichita

This form is used by employees to request Family and Medical Leave under the Family and Medical Leave Act of 1993 for their own health condition or to care for a seriously-ill family member.

How to fill out family and medical leave

How to fill out Family and Medical Leave (FMLA) Request Form

1. Obtain the Family and Medical Leave (FMLA) Request Form from your HR department or the company's website.
2. Fill out your personal information, including your name, contact details, and employee ID.
3. Indicate the reason for your leave, ensuring it aligns with the qualifying reasons under FMLA such as a serious health condition, caring for a family member, or the birth/adoption of a child.
4. Specify the dates you expect to take leave, including the start and end dates.
5. Provide any required medical documentation or certification from your healthcare provider, if applicable.
6. Review the form for accuracy and completeness.
7. Submit the completed form to your HR department as per their submission guidelines.
8. Keep a copy of the submitted form for your records.

Who needs Family and Medical Leave (FMLA) Request Form?

1. Employees who require time off for their own serious health condition, to care for an immediate family member with a serious health condition, or for parental leave related to the birth or adoption of a child.

People Also Ask about

What to write on FMLA?

If you are completing form WH-380-F, you will be required to provide information about the family member you are caring for during FMLA leave; such as their full name, your relationship to one another, and a description of your methods for providing care for that person.

What to say to get approved for FMLA?

You do not have to tell your employer your diagnosis, but you do need to provide information indicating that your leave is due to an FMLA-protected condition (for example, stating that you have been to the doctor and have been given antibiotics and told to stay home for four days).

How to write a request for FMLA leave?

Please be advised that I hereby request an FMLA leave for a period of (number of weeks) in connection with my serious health condition. The leave is to start on (date). Attached is my medical note reflecting the need for FMLA leave. Please let me know whether you approve this leave at your earliest convenience.

Are there forms to fill out for FMLA?

The Department has developed optional-use forms which can be used by employers to provide required notices to employees, and by employees to provide certification of their need for leave for an FMLA qualifying reason. These forms are electronically fillable PDFs and can be saved electronically.

What to write on FMLA paperwork for family members?

You'll need to know: Their name and relationship to you. The type of care you're providing and how much time off you need.

For pdfFiller’s FAQs

What is Family and Medical Leave (FMLA) Request Form?

The Family and Medical Leave (FMLA) Request Form is a document that employees use to request a leave of absence from work for qualifying family and medical reasons, as outlined by the Family and Medical Leave Act.

Who is required to file Family and Medical Leave (FMLA) Request Form?

Employees who are eligible for FMLA leave due to specific medical conditions or family-related reasons are required to file the Family and Medical Leave Request Form.

How to fill out Family and Medical Leave (FMLA) Request Form?

To fill out the Family and Medical Leave Request Form, an employee should provide their personal details, the reason for the leave, the expected duration of the absence, and any necessary medical documentation if required.

What is the purpose of Family and Medical Leave (FMLA) Request Form?

The purpose of the Family and Medical Leave Request Form is to formally notify the employer of the employee's intent to take leave and to provide information needed to assess the request under the FMLA guidelines.

What information must be reported on Family and Medical Leave (FMLA) Request Form?

The Family and Medical Leave Request Form must typically include the employee's name, contact information, the reason for the leave, dates of the leave, required medical information (if applicable), and any supporting documentation if requested by the employer.