Family and Medical Leave Information and Forms

Family and Medical Leave (FMLA) Information and Forms

Family and Medical Leave Act Guide (Revised June/2017) - This booklet contains information on FMLA including a description of the program, definitions of terms, eligibility information, information on how the program works and what to do if you need to use Family and Medical Leave. 

Family and Medical Leave Notification Form - Form required to notify Employee Benefits Division not to cut off health benefits

New Forms

FMLA380 - Certification of Health Care Provider for Employee’s Serious Health Condition
FMLA380  - Certification of Health Care Provider for Family Member’s Serious Health Condition
FMLA381 - Notice of Eligibility and Rights and Responsibilities
FMLA382  - Designation Notice
FMLA384  - Certification of Qualifying Exigency For Military Family Leave
FMLA385 - Certification for Serious Injury or Illness of Current Service member for Military Family Leave
FMLA413 - Family and Medical Leave Return to Work