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CS1787 REV 2/2017State of Michigan Civil Service Commission EMPLOYEE BENEFITS DIVISION 400 South Pine Street, P.O. Box 30002 Lansing, Michigan 48909 8005055011FAMILY MEDICAL LEAVE OF ABSENCE FORM
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01
Obtain the necessary forms from your employer or human resources department.
02
Fill out the employee section of the form completely and accurately.
03
Provide the required medical documentation from a healthcare provider.
04
Submit the completed form and supporting documentation to your employer within the specified timeframe.

Who needs family medical leave of?

01
Employees who need to take time off work to care for a sick family member.
02
Employees who are experiencing a serious health condition and need time off to recover.
03
Employees who are expecting a new child and need time off for parental leave.
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Family medical leave is a job-protected leave from work that allows eligible employees to take time off to care for a family member with a serious health condition.
Employers with 50 or more employees are required to provide family medical leave to eligible employees.
Employees can typically fill out a family medical leave form provided by their employer or HR department.
The purpose of family medical leave is to allow employees to take time off to care for a family member with a serious health condition without risk of losing their job.
Information such as the employee's name, the family member's name and relation, the reason for taking leave, and the duration of leave must be reported on a family medical leave form.
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