Get the free (FMLA) Request Form - Longview School District

LONGVIEW SCHOOL DISTRICT NO. 122 Employee Request for Family or Medical Leave Employee: Date: Mailing Address: City: State: Does your spouse work for Longview School District? Zip: Yes No Reason for

How to fill out fmla request form

How to fill out FMLA request form:

1. Obtain the FMLA request form from your employer or download it from their website.
2. Fill in your personal information, such as your name, address, phone number, and email address.
3. Provide details about your employment, including your job title, department, and any relevant identification numbers.
4. Indicate the reason for your FMLA request, whether it is for your own serious health condition, to care for a family member with a serious health condition, for the birth or adoption of a child, or for military caregiver leave.
5. Specify the dates when you expect the FMLA leave to start and end, if applicable.
6. Describe the anticipated medical treatment or care that you or your family member will receive during the FMLA leave period.
7. Attach any required documentation, such as medical certifications, birth certificates, or adoption papers.
8. Review the completed form to ensure all information is accurate and complete.
9. Sign and date the form before submitting it to your employer.

Who needs FMLA request form:

1. Employees who are planning to take leave under the Family and Medical Leave Act (FMLA) are required to complete the FMLA request form.
2. This form is necessary for employees who need time off for their own serious health condition, to care for a family member with a serious health condition, for the birth or adoption of a child, or for military caregiver leave.
3. Employers need this form to document and approve the employee's request for FMLA leave, as well as to ensure compliance with the law and maintain accurate records.
4. Both full-time and part-time employees are eligible to request FMLA leave, provided they meet the eligibility criteria set by the FMLA regulations.

For pdfFiller’s FAQs

What is fmla request form?

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

Who is required to file fmla request form?

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

How to fill out fmla request form?

To fill out FMLA request form, employees need to provide their personal information, details of the reason for leave, and any relevant medical documentation.

What is the purpose of fmla request form?

The purpose of FMLA request form is to formally request leave under the Family and Medical Leave Act and provide necessary information to support the request.

What information must be reported on fmla request form?

Information such as employee's name, reason for leave, expected duration of leave, and any supporting medical documentation must be reported on FMLA request form.

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