APWU

Family and Medical Leave Act (FMLA) Forms

Revised FMLA Forms

(05/31/12) The union has posted revised FMLA forms for use by healthcare providers to certify serious illnesses of APWU members and their family members. The forms the union created in 2009 “ solicit all of the information required under law,” Industrial Relations Director Mike Morris noted in a May 28, 2011, letter to USPS management. However, the APWU revised the forms based on suggestions made during a recent meeting with USPS officials to discuss the implementation of an arbitration award that stipulated that the Postal Service cannot require employees to use the Department of Labor’s WH-380 FMLA forms. [read more]

APWU Forms Available for FMLA Medical Certification

(05/02/12) The APWU FMLA Forms are once again available for employees to use when submitting medical certification for leave under the Family & Medical Leave Act (FMLA). In accordance with an April 18, 2012, award by Arbitrator Shyam Das, the Postal Service cannot require employees to use the Department of Labor’s WH-380 forms. Arbitrator Das recognized that the DOL Forms are optional forms. The USPS must accept an employee’s medical certification in any format — provided it contains all of the information required under the law. [read more]


FMLA Forms

APWU FMLA Form 1 (Revised 5/24/12) [PDF]

  • Certification by a Health Care Provider for the Employee’s Own Serious Illness

APWU FMLA Form 2 (Revised 5/24/12) [PDF]

  • Certification by a Health Care Provider for a Family Member’s serious Illness

APWU FMLA Form 3 (Revised 4/30/09 [PDF]

  • Certification by Employee of Qualifying Exigency for Military Family Leave

APWU FMLA Form 4 (Revised 4/30/09) [PDF]

  • Certification by a Service Member’s Health Care Provider for Caregiver Military Family Leave

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Sample Completed APWU 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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