Get the free Family and Medical Leave Request Form

Get Form

We are not affiliated with any brand or entity on this form

Fill out

Complete the form online in a simple drag-and-drop editor.

eSign

Add your legally binding signature or send the form for signing.

Share

Share the form via a link, letting anyone fill it out from any device.

Export

Download, print, email, or move the form to your cloud storage.

Why pdfFiller is the best tool for your documents and forms

Learn more about security

End-to-end document management

From editing and signing to collaboration and tracking, pdfFiller has everything you need to get your documents done quickly and efficiently.

Accessible from anywhere

pdfFiller is fully cloud-based. This means you can edit, sign, and share documents from anywhere using your computer, smartphone, or tablet.

Secure and compliant

pdfFiller lets you securely manage documents following global laws like ESIGN, CCPA, and GDPR. It's also HIPAA and SOC 2 compliant.

What is family and medical leave

The Family and Medical Leave Request Form is a legal document used by eligible employees of The City University of New York (CUNY) to request unpaid job-protected leave for family and medical reasons.

pdfFiller scores top ratings on review platforms

Show more Show less

Fill fillable family and medical leave form: Try Risk Free

Rate free family and medical leave form

4.4

satisfied

43 votes

Who needs family and medical leave?

Explore how professionals across industries use pdfFiller.

Family and medical leave is needed by:

CUNY employees seeking family or medical leave
Human Resources Directors handling leave requests
Personnel Officers overseeing employee leave processes
Managers involved in team leave planning
Legal advisors working on employment regulations

Comprehensive Guide to family and medical leave

What is the Family and Medical Leave Request Form?

The Family and Medical Leave Request Form is a critical document for employees at CUNY, serving as a formal request for unpaid, job-protected leave due to personal medical issues or family obligations. This form is important for employees seeking to ensure they are covered under the CUNY FMLA Policy, which safeguards their right to take leave without fear of job loss. It is essential for employees navigating the complexities of medical and family issues.

Purpose and Benefits of the Family and Medical Leave Request Form

This form serves essential purposes for employees needing to take leave. Firstly, it enables workers to apply for job-protected time off when facing significant life events. Additionally, the Family and Medical Leave Request Form allows flexibility for employees to handle their own health situations or to care for a family member, ensuring that they do not have to choose between their job and personal responsibilities.

Who Needs the Family and Medical Leave Request Form?

The Family and Medical Leave Request Form is designed for all eligible employees of CUNY. Employees who may find themselves in circumstances calling for leave include those dealing with serious health issues, significant family challenges, or other qualifying events that impact their ability to work. Understanding who qualifies for this form helps streamline the leave process for those in need.

Eligibility Criteria for the Family and Medical Leave Request Form

To qualify for the Family and Medical Leave Request Form, employees must meet specific eligibility requirements. This includes having a certain length of service with CUNY and providing appropriate notice when requesting leave. Additionally, employees must have experienced qualifying events such as serious health conditions or the need to care for family members, as outlined in the FMLA policy.

How to Fill Out the Family and Medical Leave Request Form Online

Completing the Family and Medical Leave Request Form can be done efficiently using pdfFiller. Here’s how:

Access the form through pdfFiller's online platform.
Fill out personal details, including your name and employee ID.
Select the reason for your leave from the provided options.
Input your anticipated schedule of absence.
Review the information for accuracy before submitting.

Common Errors and How to Avoid Them

When submitting the Family and Medical Leave Request Form, avoiding errors is crucial for a smooth process. Common mistakes include:

Leaving required fields incomplete.
Providing invalid leave reasons.
Neglecting to include necessary signatures.

Double-checking the form for accuracy and completeness can help prevent these issues, ensuring timely submission.

Submission Methods and Delivery

After completing the Family and Medical Leave Request Form, employees have several options for submission. They can submit the form online through pdfFiller, mail it to the appropriate department, or deliver it in person to Human Resources. It is important to be aware of any deadlines associated with the filing of the form to ensure compliance and timely processing.

What Happens After Submitting the Family and Medical Leave Request Form?

Once you submit the Family and Medical Leave Request Form, the processing begins. Employees can typically expect to receive updates regarding the status of their application. It is advisable to follow up with the HR department if there are delays or if further information is needed about the application status.

Security and Compliance of the Family and Medical Leave Request Form

Ensuring the security of sensitive information provided in the Family and Medical Leave Request Form is paramount. pdfFiller employs strong security measures, including 256-bit encryption, to protect personal data. Compliance with privacy standards such as HIPAA and GDPR further assures employees that their information is handled securely.

Use pdfFiller to Simplify Your Family Medical Leave Process

Utilizing pdfFiller can streamline the Family and Medical Leave Request process significantly. With user-friendly features such as easy form filling and eSigning, employees can manage their leave requests efficiently. This online service enables quick submissions, helping employees focus on what truly matters—taking care of their health and family needs.

Last updated on Apr 10, 2026

How to fill out the family and medical leave

1.

Access the Family and Medical Leave Request Form on pdfFiller by navigating to the provided link or searching in the pdfFiller form library.
2.

Once open, familiarize yourself with the pdfFiller interface, including the toolbar for editing and filling out forms.
3.

Gather all necessary information before starting, including your personal details, the reason for leave, and the anticipated absence schedule.
4.

Begin by filling out your personal information in the designated fields, ensuring accuracy and clarity.
5.

Navigate to the checkboxes to select your reason for leave, as specified in the form.
6.

Provide a detailed explanation of the leave reason in the appropriate section, ensuring that it aligns with CUNY FMLA Policy requirements.
7.

Review the section regarding your understanding of the leave process, making sure you acknowledge your responsibilities during the leave.
8.

Complete the signature lines by signing and dating the form, and ensure that an authorized HR representative also signs where required.
9.

Once completed, review the entire form for accuracy and completeness, checking for any missing information.
10.

Save your progress periodically using pdfFiller's save feature to avoid losing any data.
11.

After final review, download the finished form in your desired format or submit it directly through the platform, following any specified submission protocols from CUNY.

FAQs

If you can't find what you're looking for, please contact us anytime!

Contact Support

Who is eligible to use the Family and Medical Leave Request Form?

Eligible employees of The City University of New York (CUNY) can use this form to request leave under the CUNY FMLA Policy. Typically, employees must meet specific criteria related to their work hours and duration of employment.

How early should I submit my leave request?

You should submit the Family and Medical Leave Request Form as early as practicable, preferably no fewer than 30 days in advance of the anticipated start of your leave.

What documents do I need to attach when submitting the form?

The form itself should suffice; however, you may need to provide supporting documentation depending on the reason for your leave. It's best to check with your HR for specific requirements.

Can I submit my leave request electronically?

Yes, once you complete the Family and Medical Leave Request Form on pdfFiller, you can submit it electronically, following the submission protocols outlined by your HR department.

What are common mistakes to avoid when filling out this form?

Common mistakes include failing to provide complete personal information, neglecting to specify the reason for leave adequately, and not signing the form. Ensure all sections are thoroughly completed.

How long does it take to process my leave request?

Processing times can vary based on your HR department's procedures. Generally, it is advisable to allow several days for processing, especially if supporting documentation is required.

Do I need to notarize the Family and Medical Leave Request Form?

No, notarization is not required for the Family and Medical Leave Request Form. Simply complete and sign the document, and submit it as per your HR instructions.