How to Complete a FMLA Form

Congress passed the Family and Medical Leave Act in 1993. The FMLA states that an employee has the right to take off up to 12 unpaid work weeks per year for the birth of a child, placement of a foster or adopted child, care of an immediate family member or personal medical problems. Employers must grant this time off for any employee that requests it. However, the proper forms must be filed with the company's human resources department.

Things You'll Need

• Computer
• Word processor
• Printer
• Letter of recommendation
• Manila envelope

Instructions

Instructions

1. Contact your company's HR department and ask about specific company policies regarding the FMLA.

2. Obtain any company forms you must fill out and file with HR, along with your letter of request.

3. Obtain written documentation of the reason for your leave of absence. For childbirth or a medical condition concerning you or an immediate family member, ask your doctor to write a letter explaining his support of your leave. For the placement of an adopted or foster child into your home, have the issuing judge or foster care coordinator write a letter explaining the situation.

4. Download the sample FMLA Request Form (see Resources).

5. Determine which of the three forms applies best to your situation. If you plan to leave for a number of predetermined days or weeks, choose form #1; if you need to have random days off (for reasons such as prenatal checkups or birthing classes, for example), choose form #2; and if you simply require a reduced schedule for a certain amount of time, choose form #3.

6. Copy the form that fits your situation best by highlighting the text beginning with the heading and ending with the link to Department of Labor's website, clicking "Edit" in your word processor's toolbar and clicking "Copy." For example, for form #1, you would highlight from "Sample FMLA Request Form #1 -- 1 Block of Time" to the .pdf link just above the heading for section 2.

7. Paste the form into a new text document by choosing "Edit" on the toolbar and selecting "Paste."

8. Delete the heading completely.

9. Fill out the required information in the opening as indicated. In the "To" section, type the name of your HR contact.

10. Type the time frame you are requesting off in the boxes indicated in the first paragraph.

11. Edit the paragraph that begins with "It is my understanding..." so that it reflects your health insurance position. If you have health coverage through your workplace, include the sentence that is indicated. If you do not, delete everything in the brackets.

12. Print the document.

13. Check the appropriate reason for your request. If the reason is not indicated, simply write it below the final suggestion.

14. Sign the document just below the paragraph that begins with "Please let me know immediately..."

15. Compile all paperwork HR requires, your official documentation and this letter of request into a manila folder.

16. Submit the folder to your HR department.

Tips & Warnings

• While it is more common for mothers to take maternity leave, fathers are allowed a paternity leave.

References

• Family and Medical Leave Act

Resources

• Sample FMLA Request Forms