Fmla Request Form

Fmla Request Form

What Is an FMLA Request Form?

An FMLA Request Form is a document completed by employees who are eligible for time off in compliance with the Family and Medical Leave Act provisions. Prepare this form when you discover the necessity of your absence, especially if it takes more than a couple of days off. This will allow your employer or human resources department to reschedule other employees' hours, keep everyone informed of their work schedule, organize proper pay for every employee in accordance with their hours, and avoid unnecessary strain on the employees and the business as a whole.

Alternate Names:

  • FMLA Leave Request;
  • FMLA Request Letter.

You can download an FMLA Request Form template through the link below.


When are FMLA Forms Required?

You can fill out an FMLA Leave Request Form in the following circumstances:

  1. Illness or injury that temporarily prevents you from going to work.
  2. Pregnancy disability.
  3. Care for a newborn or adopted child.
  4. Care for relatives (children, spouse, parents) who have serious health conditions.
  5. Care for minor children if you need to stay home with them as their place of care or school is closed.

How to Request FMLA Leave?

FMLA Leave Request instructions are as follows:

  1. Indicate the title of the document - an FMLA Leave Request - at the top of the page.
  2. Write down your name, job title, department, mailing address, telephone number, and email address.
  3. State the start and end dates of the leave you want to request.
  4. Record the reason for submitting the request.
  5. Describe what kind of change in your employment you require - you may need to leave work for a continuous period of time (several days, weeks, or months) or you may prefer to simply reduce your work schedule - a better choice for people who deal with medical conditions and have to arrange multiple appointments with their medical providers.
  6. Sign and date the form. Once it is completed, give it to the human resources department. Prepare a copy for your direct supervisor to make sure everybody understands the situation and you will not undermine the productivity and workflow of the organization by your sudden leave.

In addition to your request, you may be asked to file a certification completed and signed by your doctor. This document will contain a description of your condition or confirmation of your pregnancy. It verifies that you are not capable to work because of the reason indicated in the certification and records the duration of the leave. In case you fail to obtain a certification from your physician, the leave request may be delayed or even denied.

When you are prepared to return to work, you will need to fill out and submit the FMLA Return to Work Form - a document that notifies the employer of your intent to come back to work and contains your physician's confirmation that you are able to safely continue your active employment.

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