FMLA Application for FMLA and Medical Release - Washoe County 2026

1. Click ‘Get Form’ to open the FMLA Application in the editor.
2. Begin by entering your Employee Name and Employee Number at the top of the form. Ensure that your contact information is accurate.
3. Fill in your Home Address, Phone Number, Department, Work Telephone Number, and Supervisor's name. This information helps in processing your application efficiently.
4. Indicate the Start Date of Anticipated Leave and Expected Date of Return to Work. This section is crucial for planning your leave.
5. Select the reason for your leave by checking one of the options provided. If applicable, provide a detailed explanation in the Reason for Leave section.
6. Specify the Leave Requested in increments of weeks or days, and indicate whether it will be paid or unpaid leave.
7. Sign and date the form at the bottom to certify your intention to return to work after your leave.

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