FMLA (Family Medical Leave Act) requires covered employers to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for the following reasons:

  • for incapacity due to pregnancy, prenatal medical care or child birth;
  • to care for the employee’s child after birth, or placement for adoption or foster care;
  • to care for the employee’s spouse, son, daughter or parent, who has a serious health condition; or
  • for a serious health condition that makes the employee unable to perform the employee’s job.

To apply for FMLA, please complete the Request Form (pages 3-4 of the information packet). You, as the employee, will complete the first page and your medical provider will complete the next page.

Further Information