Family and Medical Leave Information & Forms
This page provides necessary information that is required to request leave under the provisions of the Family and Medical Leave Act (FMLA) of 1993. Links are provided to fillable Department of Labor (DOL) forms for certification of the type of leave requested.
if you need assistance or have any questions regarding FMLA, please contact the Human Resources Leave Analyst at (540) 831-6110 or send an email to firstname.lastname@example.org.
Access the entire FMLA packet below:
Each document in the FMLA Packet can be accessed individually via the following links:
- Employee Rights & Responsibilities Under the Family and Medical Leave Act [PDF]
- Certification of Health Care Provider for Employee's Serious Health Condition [PDF]
- Certification of Health Care Provider for Family Member's Serious Health Condition [PDF]
- Certification of Qualifying Exigency For Military Family Leave [PDF]
- Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave [PDF]
- Glossary of Family and Medical Leave Terms [PDF]
- Notice of Eligibility and Rights & Responsibilities - Human Resources Use Only [PDF]
- Designation Notice - Human Resources Use Only [PDF]