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Category: Family and Medical Leave Act (FMLA) Forms

FMLA Roles & Responsibilities for Supervisors

This fact sheet assists supervisors with understanding their rights and responsibilities when they have an employee who is on FMLA leave.  For further questions not addressed you may contact your local Human Resource Office Specialist. FMLA Supervisor Rights and Responsibilities

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FMLA Fitness for Duty Certification – Return to Work Release

Employees using FMLA leave are required to provide this fitness for duty certification and intent to return to work to the health care provider who is knowledgeable regarding your reason for using FMLA.   For questions related to your FMLA, please contact your local Human Resource Office Specialist. FMLA Fitness for Duty Return to Work

FMLA Fact Sheet

This Fact Sheet provides answers to some common questions employees have about FMLA leave.  All FMLA leave must be coordinated with your local Human Resource Office. FMLA Fact Sheet

FMLA Employee Rights & Responsibilities

This fact sheet provided information related to an employee’s rights and responsibilities under the Family and Medical Leave Act.  Please work closely with your local Human Resource Office Specialist. FMLA Employee Rights & Responsibilities

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FMLA Certification Form for Qualifying Exigency for Military Leave

The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA leave due to a qualifying exigency to submit a certification.  Please work closely with your local Human Resource Office Specialist. Certification of Qualifying Exigency for Military exp 06.30.2018)

FMLA Certification Form for a Family Member

The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave to care for a covered family member with a serious health condition to submit a medical certification issued by the health care provider of the covered family member.  Please work closely with your local Human Resource Office Specialist. Certification HCP_Family Member’s Serious Health Condition exp 06.30.2018

FMLA Certification Form for Employees

The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued by the employee’s health care provider.  Please work closely with your local Human Resource Office Specialist. Certification HCP_Employee exp 06.30.2018)

FMLA Certification – Serious Illness or Injury of Service Member

The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA leave due to a serious injury or illness of a covered servicemember to submit a certification providing sufficient facts to support the request for leave.  Please work closely with your local Human Resource Office Specialist. Certification for Serious Injury or Illness of a service member exp 06.30.2018) Certification for Serious Injury or Illness of a Veteran exp 06.30.2018)

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