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Get Fmla Application
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How to fill out the Fmla Application online
Completing the Family and Medical Leave Act (FMLA) application online is an important step for users needing to secure time off for medical or family reasons. This guide provides clear instructions and helpful tips for filling out the FMLA application effectively and accurately.
Follow the steps to complete your Fmla application online.
- Click the 'Get Form' button to obtain the Fmla application and open it in your online editor.
- Fill in your personal information in the 'Employee Information' section, including your name, department, work phone, and immediate supervisor's name.
- Indicate if you are requesting full-time leave, intermittent leave, or a reduced schedule leave by checking the appropriate boxes. Specify the dates for your leave.
- If you are requesting an intermittent or reduced schedule leave, select the applicable reason for your request, such as a chronic serious health condition or planned medical treatments.
- For non-Fmla leaves, check the type of leave you wish to apply for, if applicable, and detail your preferred start and end dates for the leave.
- Read and understand the responsibilities regarding health care coverage and return to work requirements, as outlined in the application.
- Sign and date the application to confirm your understanding and agreement with the conditions stated.
- Submit your completed application to Human Resources, ensuring to keep a copy for your records. Download, print, or share the form as needed.
Begin your Fmla application online today to secure your leave.
To apply for FMLA, the employee must take an FMLA Medical Certification Form to their health care provider. This form ensures that the employee's or family member's applicable health condition is valid. After receiving the form, the employee must return it within 15 calendar days.
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