Follow the steps to complete your form online

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by entering your personal information in the fields provided, including your name, date of hire, employee ID number, and service unit to ensure proper identification.
3. Provide your contact information by filling in your phone number. This allows for direct communication regarding your leave request.
4. Fill in your job title and your supervisor's name. This information helps in processing your request effectively.
5. Select either ‘Agreement’ or ‘Non Agreement’ by checking the appropriate box, as this will impact the terms of your leave.
6. In the section titled ‘Request for Family/Medical Leave,’ indicate the reason for your leave by checking the applicable box. If relevant, include the estimated date of birth or placement of a child or specify the serious health condition affecting you or your family member.
7. Next, specify if your leave will be continuous or intermittent by selecting the corresponding option. Provide the starting date and, if applicable, the ending date of your leave.
8. Ensure that you check the boxes indicating whether you meet eligibility criteria for FMLA by confirming your total months of service and actual hours worked.
9. Review the medical certification requirements highlighted in the instructions and ensure you understand the need to have your health care provider complete the necessary documentation.
10. Once all fields are completed, save your changes. You will have options to download, print, or share the form for submission. Be sure to retain a copy for your records.

Complete your Union Pacific Fmla Form 16874 online now to initiate your family or medical leave request.