Get Request For Family Or Medical Leave Form

Filling out the Request For Family Or Medical Leave Form online is an important step in securing the time off you need for personal or family health matters. This guide will walk you through each section of the form clearly and concisely.

Follow the steps to complete your form online:

1. Click 'Get Form' button to access the form and open it in your preferred document editor.
2. Begin by entering your name in the designated field to identify yourself clearly.
3. Fill in your employee ID number, ensuring the accuracy of this crucial identifier.
4. Complete your address, home phone number, email address, and current employment status by selecting 'Full-time' or 'Part-time' as applicable.
5. Include your work phone number, department, and both U.Va. hire date and state hire date in the respective fields.
6. Indicate the reason for your leave by checking the appropriate box and filling in the leave start date and expected return date.
7. If applicable, provide additional details regarding the reason for leave in the space provided.
8. State whether you have taken family or medical leave in the past calendar year by checking 'Yes' or 'No', and if 'Yes', indicate the number of workdays.
9. Read and agree to the provisions listed, providing your signature and the date in the space provided.
10. Ensure your supervisor's details are filled in correctly, including their name, work phone number, and signature, punctuating the completion of your request.
11. Finalize your process by saving changes, then download, print, or share the completed form as needed.

Complete your forms online to streamline your request process.