Family and Medical Leave Act (FMLA) Request Form To be 2026

1. Click ‘Get Form’ to open the Family and Medical Leave Act (FMLA) Request Form in the editor.
2. Begin by entering your personal information, including your name, job title, department, home address, and contact details. Ensure all fields are filled accurately.
3. Indicate whether you are currently on another leave or have been on FMLA prior to this request by selecting 'Yes' or 'No'. If applicable, specify the type of leave.
4. Provide the reason for your leave of absence by checking the appropriate box. You can also specify other reasons if necessary.
5. Fill in the requested start date and anticipated end date for your leave. If applicable, include dates for rolling or intermittent leave.
6. Review the section regarding accrued sick leave and other paid time off options. Make sure to understand your rights and responsibilities during this process.
7. Sign and date the form at the bottom before submitting it for approval from your department head.

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