Get Employee Fmla Request Form - City Of Toledo

The Employee Fmla Request Form is an essential document for employees seeking to request leave under the Family and Medical Leave Act. This guide provides clear, step-by-step instructions on how to complete the form online, empowering users to navigate the process effortlessly.

Follow the steps to accurately complete your Fmla request.

1. Click ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by filling in your name in the designated field to identify yourself as the applicant.
3. Complete the division or department field to indicate the area of your employment.
4. Enter your job classification to provide additional context about your role.
5. In the required phone number fields, provide both your home or cell phone number and your work phone number for contact purposes.
6. Fill in your home mailing address, making sure to include the city, state, and zip code as they are required.
7. If applicable, provide your date of birth or the date of adoption for the related request.
8. If your request is for a family member, state their name and your relationship to them in the specified area.
9. Select the basis for your Fmla request by checking the appropriate option related to your situation, such as birth, care for a family member, or your own serious health condition.
10. Indicate the supporting documentation you are attaching by marking the relevant certification source, such as a health care provider.
11. Specify the number of hours, days, or weeks you are requesting by circling the corresponding option.
12. Determine whether the leave will be taken in a block of time or intermittently by marking the appropriate option.
13. Select your preferred sequence for utilizing leave time by marking either sick time, vacation, or unpaid leave.
14. If applicable, specify any other details regarding your leave request.
15. The division payroll clerk must fill out their information, including the date received and the date sent to HR.
16. Confirm your eligibility by ensuring that the required conditions are met, such as having worked for the past 12 months and having not exhausted your Fmla leave.
17. Once all fields are completed, save your changes, download the form, print it, or share it as needed.

Complete your Employee Fmla Request Form online today to ensure a smooth application process.