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FMLA Application for FMLA and Medical Release - Washoe County 2026
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- Click ‘Get Form’ to open the FMLA Application in the editor.
- Begin by entering your Employee Name and Employee Number at the top of the form. Ensure that your contact information is accurate.
- Fill in your Home Address, Phone Number, Department, Work Telephone Number, and Supervisor's name. This information helps in processing your application efficiently.
- Indicate the Start Date of Anticipated Leave and Expected Date of Return to Work. This section is crucial for planning your leave.
- 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.
- Specify the Leave Requested in increments of weeks or days, and indicate whether it will be paid or unpaid leave.
- Sign and date the form at the bottom to certify your intention to return to work after your leave.
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