| Form Name |
Available
Formats
(Icon Legend) |
Form Descriptions |
FML: Q & A's
|
 |
Questions and answers regarding Family Medical Leave (FML). |
| FML
Request Form |
|
To request FML leave for a serious health condition
(to be completed by employee). |
| FML: Certification of Health Care Provider for Employee's Serious Health Condition |
External Site
|
To support an employee's FMLA leave request due to the employee's own serious health condition (to
be completed by the employee, employer, and the employee's health care provider). |
| FML: Certification of Health Care Provider for Family Member's Serious Health Condition |
External Site
|
To support an employee's FMLA leave request due to a family member's serious health condition (to
be completed by the employee, employer, and the family member's health care provider). |
| FML: Certification of Qualifying Exigency for Military Family Leave |
External Site
|
To support an employee's FMLA leave request due to a qualifying military exigency (to be completed by the employee and employer). |
| FML: Certification for Serious Injury or Illness of Covered Servicemembers - for Military Family Leave |
External Site
|
To support an employee's FMLA leave request due to the serious health condition of a covered servicemember (to be completed by the employee or covered servicemember, employer, and DOD health care provider). |
| Leave Share Donation Form |
|
To donate leave to leave share program participants
(to be completed by employee donating leave). |
| Leave Share Transfer Request Form |
|
To request leave donations from the leave
share program (to be completed by employee receiving donated leave). |
|
Leave
Without Pay Request Form (FML, Sick Leave, Leave of Absence)
|
|
To arrange benefit payments while on FML leave w/o pay (FMLWOP), sick leave w/o pay (SLWOP), or leave of absence w/o pay (LOAWOP). |
