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Human Resources
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FMLA Application Procedures

If an employee is off more than three work days, the Office of Human Resources (HR) should be contacted. HR will mail an FMLA packet to the employee or it can be downloaded using the FMLA Packet link below under FMLA forms and Instructions.

The required documentation will include the following:

  • FMLA PACKET: This should be completed by the employee, signed by the supervisor and returned to HR
  • MEDICAL CERTIFICATION/PHYSICIAN'S STATEMENT: This should be completed by the employee's doctor and returned to HR

HR will review the Physician's Statement to determine if the employee will be granted family medical leave. The employee and the employee's supervisor will be notified in writing whether or not FMLA leave is granted. If leave is granted, the employee will be notified when an updated Physician's Statement will be required.

FMLA Forms and Instructions
Employee Rights and Responsibilities under FMLA are provided within the FMLA packet, linked below. Please read the information thoroughly before completing the FMLA forms.

Employees need to complete the entire FMLA packet and the appropriate Medical Certification form.

FMLA Packet pdf icon

Medical Certifications:

(Please choose one)
Employee's Serious Health Condition
Family Member's Serious Health Condition
Serious Injury or Illness of Covered Service member
Leave Certification for Qualifying Exigency