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Fmla dependent care form 2026
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- Click ‘Get Form’ to open the FMLA Dependent Care Form in the editor.
- Begin by entering the date at the top of the form. This is essential for tracking your request.
- Fill in your supervisor’s name and department, followed by your name and employee ID number.
- Indicate the type of leave you are requesting by checking either 'Paid Dependent Care Leave' or 'Family Medical Leave'. Specify the duration of your leave in days and the start and end dates.
- Select the reason for your leave from the provided options, ensuring you complete any necessary certifications as indicated.
- Review all instructions regarding submission timelines and requirements for documentation to ensure compliance with company policies.
- Sign and date the form before submitting it to your supervisor, ensuring that all fields are completed accurately.
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Related links
While use of this form is optional, this form asks the health care provider for the information necessary for a complete and sufficient medical certification,
Family members serious health condition, form WH-380-F - Use when a leave request is due to the medical condition of the employees family member. member,