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CITY OF BROCKTON Family and Medical Leave Act (FMLA) Request Form To be completed by employee: Employee Name:Job Title:DepartmentHome Address: Initial Application Home Phone:Employee ID #:PERSONAL

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How to fill out family and medical leave

01

Collect the necessary documentation, such as medical records or birth certificates.

02

Determine if you are eligible for family and medical leave based on your employment status and the size of your employer.

03

Notify your employer of your need for leave as soon as possible, preferably in writing.

04

Fill out the required forms provided by your employer, including the FMLA application.

05

Provide any additional documentation or information requested by your employer.

06

Follow any procedures or policies outlined by your employer for requesting and taking family and medical leave.

07

Keep track of your leave usage and any changes in your circumstances that may affect your eligibility or entitlement to leave.

08

Communicate any changes or updates to your employer during your leave period.

09

Return to work promptly at the end of your approved leave period, unless otherwise agreed upon with your employer.

10

Follow any additional steps or procedures required by your employer to ensure a smooth transition back to work.

Who needs family and medical leave?

01

Family and medical leave is needed by individuals who require time off from work to address their own serious health conditions, to care for a family member with a serious health condition, or to bond with a newborn or newly adopted child.

02

Employees who need to take leave for the care of a covered service member with a serious injury or illness are also eligible for family and medical leave.

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What is family and medical leave?

Family and medical leave allows eligible employees to take time off work for certain family and medical reasons.

Who is required to file family and medical leave?

Employers are required to provide family and medical leave to eligible employees.

How to fill out family and medical leave?

Employees can fill out the necessary forms provided by their employer to request family and medical leave.

What is the purpose of family and medical leave?

The purpose of family and medical leave is to provide employees with time off work for specific family and medical reasons without risking their job security.

What information must be reported on family and medical leave?

Employees must report the reason for their leave, the duration of their leave, and any supporting documentation required by their employer.

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