Family and Medical Leave Act
Your Rights Under the Family and Medical Leave Act
The Family and Medical Leave Act (FMLA) provides an entitlement of up to 12 weeks of job-protected, unpaid leave during any 12-month period to eligible, covered employees for the following reasons: 1) birth and care of the eligible employee's child, or placement for adoption or foster care of a child with the employee; 2) care of an immediate family member (spouse, child, parent) who has a serious health condition; or 3) care of the employee's own serious health condition. It also requires that employee's group health benefits be maintained during the leave. For more information regarding your rights under FMLA, please review the links below.
FMLA Request for Leave Form
FMLA Health Care Provider Certification Forms
- Employee Serious Health Condition Physician Certification Form
- Family Member's Serious Health Condition Physician Certification Form
- Certification of Qualifying Exigency for Military Family Leave
- Certification for Serious Injury or Illness of Current Servicemember for Military Family Leave
- Certification for Serious Injury or Illness of a Veteran Servicemember for Military Family Leave
FMLA Intermittent Timesheet
Return to Work Form
- Fitness-For-Duty Form (This form must be completed by your physician prior to your return to work).
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