Family Medical Leave (FMLA)

Basic Leave Entitlement

FMLA requires covered employers to provide up to 12 weeks of unpaid, job-protected leave to eligible employees
for the following reasons:

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

Use of Leave

An employee does not need to use this leave entitlement in one block. Leave can be taken intermittently or on a reduced leave schedule when medically necessary. Employees must make reasonable efforts to schedule leave for planned medical treatment so as not to unduly disrupt the employer’s operations. Leave due to qualifying exigencies may also be taken on an intermittent basis.


This form should be completed by the employee when the employee requests FML:

This form must be submitted to Human Resources by either employee or employee’s department manager/supervisor
for all Family Medical Leaves.

FMLA Recertification Letter for Employee's or Family Member's Serious Health Condition

Military Family Leave Entitlements