Fmla 2026

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The document is a Family and Medical Leave Request Form that allows eligible employees to request up to twelve weeks of unpaid, job-protected leave for specific family and medical reasons under the Family and Medical Leave Act. It outlines the eligibility criteria, required information for the request, reasons for leave, and sections for employee, supervisor, and human resources to complete.

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Click ‘Get Form’ to open the Family and Medical Leave Request Form in the editor.
Begin by entering the date at the top of the form. Then, fill in your name, Social Security Number, job title, and supervisor's name.
In the eligibility section, answer the questions regarding your employment duration and hours worked. If you answer 'yes' to both, proceed to the next question.
Provide details about any previous medical or family leave taken, including dates and reasons for leave.
Indicate your reason for requesting leave by circling one of the options provided. Fill in additional details as necessary.
Specify the dates of leave requested and any intermittent or reduced schedule requests in the designated sections.
Complete your employee statement by signing and dating it at the bottom of the form.

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