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FMLA Leave Request Form - Free HR Template | ZenBuild | ZenBuild

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FMLA Leave Request Form

Collect employee information for Family and Medical Leave Act (FMLA) leave requests with qualifying reason details.

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FMLA Leave Request Form

Collect employee information for Family and Medical Leave Act (FMLA) leave requests with qualifying reason details.

Employee Full Name*

Work Email*

Employee ID*

Department and Manager*

Proposed Leave Start Date*

Anticipated Return Date*

FMLA Qualifying Reason*

Leave Type Requested*

Continuous leaveIntermittent leaveReduced schedule leave

Will you be using accrued PTO concurrently?*

YesNo

Additional information for HR

Template Details

CategoryHR

IndustryHuman Resources

Fields10

Uses0

Views1

FMLAleave of absencemedical leavefamily leave