Family and Medical Leave Act

How to Apply for Family and Medical Leave Act (FMLA)

Step 1

Review the General Notice: Employee Rights Poster in English or Spanish  and submit your request for FMLA to the Leave of Absence (LOA) Team by filling out the Family and Medical Leave Act (FMLA) Request Form

Step 2 

The LOA Team will review your request, and send you a WH-381: Eligibility and Rights and Responsibilities Notice, which informs you of the specific expectations and obligations associated with a FMLA leave request and the consequences of failure to meet those obligations. Additionally, this notice will preliminarily approve or deny your request.

Step 3

The LOA Team will send you a WH-382: Designation Notice, which informs you if the certification is incomplete or insufficient and additional information is needed, and/or whether the FMLA leave request is approved. This form will also provide you with the amount of leave that is designated and counted against your FMLA entitlement.