Get the free FMLA Leave Request Form 9 14

FAMILYMEDICALLEAVEREQUEST Instructions:Completethisformandhaveitsignedbyemployeessupervisor. AttachtheappropriateandcompletedCertificationformthatis indicated below. ReturnbothformstotheOfficeofHumanResources.

How to fill out fmla leave request form

1. To fill out the FMLA leave request form, begin by obtaining the form from your employer or downloading it from their website if available.
2. Start by entering your personal information at the top of the form, including your name, employee ID number, and contact details.
3. Next, provide the date on which you plan to start the FMLA leave and indicate whether it is a continuous leave or intermittent leave, which may involve intermittent time off or reduced work hours.
4. Specify the reason for your FMLA leave, which may include your own serious health condition, the need to care for a family member with a serious health condition, or to bond with a new child.
5. If applicable, provide additional documentation or medical certifications to support your request. This may include a doctor's note or documentation of your family member's condition.
6. Indicate the duration of your anticipated leave, including the start and end dates. If you're unsure of the exact end date, state your intent to return to work as soon as possible.
7. Consider including any reasonable accommodations or modifications that may be necessary for your return to work, as per the Americans with Disabilities Act (ADA).
8. Finally, sign and date the form to affirm the accuracy and truthfulness of the information provided.

Who needs the FMLA leave request form?

1. Employees who are eligible for FMLA leave and need to request time off for their own serious health condition, the care of a family member with a serious health condition, or to bond with a new child.
2. Employers who require documentation and formal request for FMLA leave to ensure compliance with the law and to properly track employee absences.
3. Human resources departments within organizations that manage employee leave and need to review, approve, and keep records of FMLA leave requests.

For pdfFiller’s FAQs

What is fmla leave request form?

FMLA leave request form is a document used by employees to request leave under the Family and Medical Leave Act (FMLA).

Who is required to file fmla leave request form?

Employees who need to take leave for qualifying reasons under FMLA are required to file the FMLA leave request form.

How to fill out fmla leave request form?

Employees can fill out the FMLA leave request form by providing their personal information, the reason for the leave, the dates of the leave, and any supporting documentation.

What is the purpose of fmla leave request form?

The purpose of the FMLA leave request form is to notify the employer of the employee's need for leave under FMLA and to provide documentation of the reason for the leave.

What information must be reported on fmla leave request form?

The FMLA leave request form must include the employee's name, the reason for the leave, the requested dates of leave, and any supporting documentation.

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