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Family and Medical Leave Forms

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Family and Medical Leave Forms
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Employees should contact Human Resources for counseling before completing these forms.

Employee Rights and Responsibilities Under the Family Medical Leave Act (PDF)
FMLA Information (PDF)
Request for FMLA Form (PDF)
Certification of Health Care Provider for Employee's Serious Health Condition (PDF)
Certification of Health Care Provider for Family Member's Serious Health Condition (PDF)
Certification for Serious Injury or Illness of Covered Servicemember for Military Family Medical Leave PDF)
Certification of Qualifying Exigency for Military Leave (PDF)
Leave Without Pay & Insurance Continuation (PDF)
Request for Sick Leave Pool Hours (PDF)
Return to Work Status Form (PDF)

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Publish date: May 13, 2024

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