An employee may submit a request for an extended leave of absence. Under the FMLA laws their employment will be secure for a specified period of time if they meet all of the necessary requirements.

The Employee Request for FMLA Leave Form is a convenient format to obtain the information necessary to base your decision on the request. Accompanying this form should be a proposed work schedule. This form explains the basic FMLA laws as well as acquires information on the reason for the leave. We also offer the Response to FMLA Leave Request Form and the FMLA Health Care Provider Forms so that proper documentation can be obtained in written form for both you and your employee.

• This form is 8.5" x 11"
• Downloadable PDF