Request for family and medical leave (fmla) 2025

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Dear (Supervisor / HR Manager): Please be advised that I hereby request an FMLA leave for a period of (number of weeks) in connection with my serious health condition. The leave is to start on (date).
Eligible employees can take FMLA leave to care for a child, spouse, or parent who has a serious health condition. Caring for a family member under the FMLA includes assistance with basic medical, hygienic, nutritional, safety, transportation needs, physical care, or psychological comfort.
You do not have to tell your employer your diagnosis, but you do need to provide information indicating that your leave is due to an FMLA-protected condition (for example, stating that you have been to the doctor and have been given antibiotics and told to stay home for four days).
To take FMLA leave, you must provide your employer with appropriate notice. If you know in advance that you will need FMLA leave, you must give your employer at least 30 days advance notice.
Bring the form with you. Tell them what you are experiencing, why you are experiencing it, and how it is affecting your health and well being. Let them know that you think you would benefit from time off work, but need their support to do so.
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To take FMLA leave, you must provide your employer with appropriate notice. If you know in advance that you will need FMLA leave, you must give your employer at least 30 days advance notice. If you know you need leave less than 30 days in advance, you must give your employer notice as soon as you can.

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