Employee FMLA Leave Request: Fill out & sign online

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Click ‘Get Form’ to open the Employee FMLA Leave Request in our editor.
Begin by filling out your personal information in the 'Employee Information' section. Include your name, employee ID, address, job title, department, today's date, and status (full-time, part-time, or temporary).
Indicate your primary and secondary telephone numbers for contact purposes.
In the 'Reason for Requesting Leave' section, check all applicable boxes that describe your reason for leave. Be sure to specify relationships where necessary.
Fill in the expected start and end dates of your leave under 'Duration of Leave'. If you are requesting intermittent leave, provide a brief explanation of your proposed schedule.
Add any additional notes that may be relevant to your request in the 'Additional Notes' section.
Finally, certify the accuracy of your information by signing and dating the form in the 'Employee Certification and Signature' section.

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What proof do you need for FMLA?

Certification forms. The FMLA does not require the use of any specific certification form. The Department has developed optional forms that can be used for leave for an employees own serious health condition (WH-380-E) or to care for a family members serious health condition (WH-380-F).

How do you request FMLA from your doctor?

5 Tips for Requesting FMLA Leave Notify your employer as soon as you know you need time off. Complete a medical certification within 15 days of providing notice. Allow time for your doctors office to complete the paperwork. Contact your employer if your FMLA needs change while you are on leave.

Does an employee need to request FMLA?

Employees do not have to specifically ask for FMLA leave but do need to provide enough information so the employer is aware the leave may be covered by the FMLA.