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Click ‘Get Form’ to open the FMLA Leave Request Form in the editor.
Begin by filling out Part I: Leave Request Data. Enter your name, address, and home telephone number. Select the reason for your leave by checking the appropriate box.
Provide additional details such as the due date for childbirth or the name and relationship of a seriously ill family member if applicable.
Indicate the dates you wish to start and return from leave. If requesting intermittent leave or a reduced work schedule, provide an explanation in the designated fields.
Complete Part II by acknowledging your responsibilities regarding benefits during your leave. Sign and date this section.
Finally, ensure that your supervisor completes Part III by signing and providing their contact information before submitting the form to Human Resources.
Start using our platform today to easily complete your FMLA paperwork for free!
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