APWU
Family and Medical Leave Act (FMLA) Forms

(04/30/09) These revised forms provide supporting documentation required by current regulations for leave requests covered by the Family and Medical Leave Act (FMLA).

APWU FMLA Form #1 [pdf]

CERTIFICATION BY EMPLOYEE’S HEALTH CARE PROVIDER FOR EMPLOYEE’S SERIOUS ILLNESS

APWU FMLA Form #2 [pdf]

HEALTH CARE PROVIDER CERTIFICATION OF EMPLOYEE’S FAMILY MEMBER SERIOUS ILLNESS

APWU FMLA Form #3 [pdf]

CERTIFICATION BY EMPLOYEE OF QUALIFYING EXIGENCY FOR MILITARY FAMILY LEAVE

APWU FMLA Form #4 [pdf]

CERTIFICATION BY SERVICE MEMBER’S HEALTH CARE PROVIDER FOR CAREGIVER MILITARY FAMILY LEAVE

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Sample Completed Forms

Sample Form for Employee's Absence Plus Treatment

Sample Form for Child with Chronic Condition

Sample Form for Chronic Condition

Sample Form for Hospital Stay

Sample Form for Long Term-Terminal Illness

Sample Form for Multiple Treatments

Sample Form for Pregnancy

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