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The Family and Medical Leave Forms 1 Business/Services Section
Montana Family and Medical Leave Form
 This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Montana. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Nebraska Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Nebraska. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Nevada Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Nevada. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
New Hampshire Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in New Hampshire. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
New Jersey Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in New Jersey. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
New Mexico Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in New Mexico. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
New York Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in New York. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
North Carolina Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in North Carolina. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
North Dakota Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in North Dakota. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Ohio Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Ohio. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Oklahoma Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Oklahoma. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Oregon Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Oregon. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Pennsylvania Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Pennsylvania. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Rhode Island Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Rhode Island. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
South Carolina Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in South Carolina. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
South Dakota Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in South Dakota. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Tennessee Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Tennessee. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Texas Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Texas. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Utah Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Utah. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Vermont Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Vermont. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Virginia Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Virginia. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Washington Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Washington. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
West Virginia Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in West Virginia. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Wisconsin Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Wisconsin. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |
Wyoming Family and Medical Leave Form
| This form is to be used to comply with the Federal Family and Medical Leave Act which requires that eligible employees be entitled to up to 12 weeks of unpaid and job-protected leave for certain family and medical reasons. This form is for use in Wyoming. Among others, this form includes the following provisions: • Eligibility • Reasons for requested leave |