Family Medical Leave (FML)
Family and Medical Leave is a benefit that provides eligible employees up to 12 weeks of unpaid leave in a 12 month period for:
• the birth and care of a newborn child of the employee;
• the placement with the employee of a son or daughter for adoption or foster care;
• to care for a spouse, son, daughter, or parent with a serious health condition;
• to take medical leave when the employee is unable to work because of a serious health condition; or
• for qualifying exigencies arising out of the fact that the employee’s spouse, son, daughter, or parent is on active duty or call to active duty status as a member of the National Guard or Reserves in support of a contingency operation.
How to Apply for Family Medical Leave
You must complete the Request for Family or Medical Leave form, including your supervisor’s signature. Your department keeps the original; you keep a copy and send a copy to HR. Please have the healthcare provider complete the appropriate Certification of Health Care Provider form, depending on whether the request is for you or a family member. The provider’s office can send the completed form to Human Resources, via fax to 972.883.2156, or via email to email@example.com.
- Request for Family or Medical Leave
- Appropriate Certification of Health Care Provider:
Click on the above link to view a list of Employment staff that can assist you
Last Updated: December 1, 2014