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Family Medical Leave Act (FMLA)

For an overview of eligibility requirements, definitions for immediate family, length of leave, benefits, protections and other relevant information on the Family and Medical Leave Act, please review HR Policy 4-600 Family and Medical Leave (FMLA). 

Services

Fill out Family and Medical Leave Request Form

Fill out Employee Serious Health Condition Form

Fill out Family Serious Health Condition Form

Resources

Eligible employees are entitled to:

  • Twelve workweeks of leave in a 12-month period for:
    • The birth of a child and to care for the newborn child within one year of birth;
    • The placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement;
    • To care for the employee’s spouse, child, or parent who has a serious health condition;
    • A serious health condition that makes the employee unable to perform the essential functions of his or her job;
    • Any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty.”
  • Twenty-six workweeks of leave during a single 12-month period:
    • To care for a covered service member with a serious injury or illness if the eligible employee is the service member’s spouse, son, daughter, parent, or next of kin (military caregiver leave)

Administrative FMLA Forms

For agency use only

FMLA Designation Notice

FMLA Notice of Eligibility - Rights and Responsibilities