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Step 1: To request FMLA, please complete the following form. If you complete the Print Version, please submit it to Human Resources at

Step 2: Once Human Resources has processed this document, you will receive the following forms via email: 

  • Cover Letter

  • Certification of Health Care Provider (will need to be returned before you can be approved for leave)

  • Eligibility Notice & Rights and Responsibilities

  • Fitness for Duty Form (will need to be returned at end of leave)

Step 3: Have completed and submit the Certification of Health Care Provider's form.

An employee requesting FMLA is required to complete a FMLA leave Certification of Health Care Provider form and submit the form to Human Resources before any leave commences. This form is to be completed by either the employees health care provider or by the family member's health care provider. This form should be returned to Human Resources within 15-20 days. Failure to complete this form may delay or prevent leave approval. If this information is not received in the required timeframe, the leave will be considered unauthorized.

Step 4: Once Human Resources has received the Certification of Health Care Provider's form, we will send the following document to the employee via email: 

  • Designation Notice

Maternity and Paternity Leave
Employees going on Maternity or Paternity leave will need to submit a FMLA request form. Once processed, you will receive a designation notice. (Maternity and Paternity leave does not require a completed doctor's portion) 

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