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Benefits OfficeAPPLICATION FOR FAMILY MEDICAL LEAVE ACT/ CALIFORNIA FAMILY RIGHTS ACT LEAVE NAME : ___ DIVISION:___ SOC. SEC #: ___CAMPUS:___ Beginning Date of Leave: ___Ending Date of Leave:___Reason

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How to fill out family and medical leave

01

Obtain the necessary forms from your employer.

02

Provide any required documentation such as a medical certification for the leave.

03

Fill out the forms accurately with information about the reason for the leave and the dates you will be taking off.

04

Submit the completed forms to your employer within the required timeframe.

Who needs family and medical leave?

01

Employees who need to take time off work to care for a newborn child or newly adopted child.

02

Employees who need to care for a family member with a serious health condition.

03

Employees who have a serious health condition that prevents them from working.

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What is family and medical leave?

Family and medical leave is a job-protected leave of absence for eligible employees to care for their own medical needs or the medical needs of a family member.

Who is required to file family and medical leave?

Employees who meet the eligibility requirements set by the Family and Medical Leave Act (FMLA) are required to file for family and medical leave.

How to fill out family and medical leave?

Employees can request family and medical leave by completing the necessary forms provided by their employer and submitting any required documentation.

What is the purpose of family and medical leave?

The purpose of family and medical leave is to provide employees with job-protected time off for their own medical needs or to care for a family member.

What information must be reported on family and medical leave?

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

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