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FAMILY AND MEDICAL LEAVE RETURN TO WORK MEDICAL CERTIFICATION FORM PART EMPLOYEE Informational: Social Security Number:Title: Department: Date Leave Commenced: Date of Return to Work: Employee's signature:

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What is family and medical leave?

Family and medical leave is a labor law that allows employees to take unpaid leave for certain family and medical reasons.

Who is required to file family and medical leave?

Employers with 50 or more employees are required to provide family and medical leave.

How to fill out family and medical leave?

Employees can fill out the necessary forms provided by their employer or human resources department.

What is the purpose of family and medical leave?

The purpose of family and medical leave is to allow employees to take time off work for family or medical reasons without fear of losing their job.

What information must be reported on family and medical leave?

Employees must report the reason for their leave, the start and end dates, and any documentation required by their employer.

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