Fmla Leave Form PDF Details

Fulfilling the requirements of the FMLA Leave Request Form marks a critical point for employees seeking time away from work due to personal or family health matters. This comprehensive document, presented to the Human Resource Office, navigates through various sections aimed at capturing essential information. It starts with the basic details of the employee, including their name and department, followed by a clear delineation of the leave type -- whether it's for a full-time absence or on an intermittent or reduced-schedule basis. The form caters to a range of circumstances, providing options for leave due to the birth or adoption of a child, caring for a spouse, child, or parent with a serious health condition, the employee's own health condition, or other specified reasons. Furthermore, it addresses the potential substitution of paid leave, which includes options such as vacation or sick hours, thereby offering an inclusive approach towards managing the employee's time off. A noteworthy feature is the provision for employees to provide contact information, ensuring ongoing communication. The formalities conclude with spaces for both the employee's and the approver's signatures, signifying consent and acknowledgment from both parties involved.

QuestionAnswer
Form NameFmla Leave Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesemployee sample filled fmla form, fmla request form template, fmla employee request form, fmla forms 2021 printable

Form Preview Example

FMLA LEAVE REQUEST FORM

(The following request is to be completed and returned to the Human Resource Office)

EMPLOYEE REQUEST

Employee’s Name

Employee’s Department

Date

Request for Full-Time Leave

 

 

I request a leave of absence from

(date) to

(date)

for the following reason:

For birth of my child and/or to care for the newborn child.

For placement of a child with me for adoption or foster care.

To care for my (circle one): spouse, child or parent with a serious health condition. Name:

My own serious health condition.

For another reason. (Please specify):

Request for Intermittent or Reduced-Schedule Leave

I request intermittent leave or reduced-schedule leave at the following times:

Schedule:

Reason:

Substitution of Paid Leave

I request to use (check all that apply):

Paid Vacation

Sick Hours

Location During Leave

 

Other

I can be reached at the following address and phone number during my leave:

Employee Signature

Approved By

Date

© The Personnel Advisor

907

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fmla request form fields to fill out

In the field I request intermittent leave or, Schedule, Reason, Substitution of Paid Leave, I request to use check all that, Paid Vacation, Sick Hours, Other, Location During Leave, I can be reached at the following, Employee Signature, Approved By, Date, and The Personnel Advisor type in the information which the system requires you to do.

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