Leave of Absence
Family Medical Leave Information and Paperwork
Complete all of the steps below
Explanation of FMLA Forms - This form is used to explain the FMLA process to you.
FMLA Request Form - Complete this form as best you can; FMLA dates are subject to change. Indicate the number of days needed off and the type of time off you will be using (sick, unpaid, etc.). Once you have completed this form, have your supervisor sign it and submit it to HR.
Notice of Eligibility - Human Resources will complete this form and provide you with a copy.
Choose the applicable form; if you do not see the applicable certification, please contact human resources.
Certification of Health Care Provider for Family Member's Serious Health Condition
Certification of Health Care Provider for Employee's Serious Health Condition
Fitness for Duty - Completed by the medical provider, the form must be returned to Human Resources prior to your return to work. Your doctor may fax this to 715-723-8554.