Family and Medical Leave (FMLA) Information and Forms

Family and Medical Leave Act Guide (Revised Januaryt/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. This is a Microsoft Word document

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