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P 559.278.2032 REQUEST FOR MEDICAL LEAVE CALIFORNIA STATE UNIVERSITY, FRESNO HUMAN RESOURCES SECTION 1. EMPLOYEE INFORMATION Fax 559.278.4275 EMPLOYEE NAME FRESNO STATE ID# HOME/CELL PHONE DEPARTMENT
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How to fill out medical leave application

01
Obtain a medical leave application form from your employer or human resources department.
02
Provide your personal information, including your name, employee number, and contact details.
03
Indicate the reason for your medical leave and the dates you will be absent from work.
04
Attach any necessary supporting documentation, such as a doctor's note or medical certificate.
05
Submit the completed medical leave application form to your employer or human resources department.
06
Keep a copy of the application for your records and follow up with your employer if necessary.

Who needs medical leave application?

01
Employees who are experiencing health issues and are unable to perform their job duties.
02
Employees who require time off for medical appointments, surgeries, or other medical treatments.
03
Employees who are recovering from an illness, injury, or medical condition.
04
Employees who need to care for a family member or dependent who is ill and requires their support.
05
Employees who are pregnant and need time off for prenatal care or maternity leave.
06
Employees who have a chronic health condition that occasionally requires medical leave.
07
Employees who need time off for mental health reasons or to manage stress-related conditions.
08
Employees who are eligible and have accrued sick leave or medical leave credits as part of their employment benefits.
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Medical leave application is a formal request submitted by an individual to their employer seeking permission to be absent from work due to medical reasons.
Employees who need to take time off work for medical reasons are required to file a medical leave application.
To fill out a medical leave application, the employee must provide their personal information, the reason for requesting leave, and any supporting medical documentation.
The purpose of a medical leave application is to inform the employer of the employee's need to take time off work for medical reasons and to request approval for the leave.
Information such as the employee's name, contact information, date of requested leave, reason for leave, and any accompanying medical documentation must be reported on a medical leave application.
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