Human Resources
FMLA Forms
1. FMLA CERTIFICATION FORMS (to be completed by health care provider and employee)
- Employee's Serious Health Condition Certification of Health Care Provider (23 KB PDF)
- Family's Serious Health Condition Certification of Health Care Provider (23 KB PDF)
- Qualifying Exigency for Military Family Leave Certification Form (22 KB PDF)
- Serious Injury or Illness of Covered Service Member Certification of Health Care Provider (25 KB PDF)
2. FMLA EMPLOYEE'S LEAVE REQUEST (to be completed by employee)
- Leave Request (321 KB Word Doc)
3. FMLA NOTICES (to be completed by Administrator and provided to employee)
- Notice of Eligibility and Rights and Responsibilities (306 KB Word Doc)
- Notice of Designation (299 KB Word Doc)