Family and Medical Leave Act Instructions PDF
This PDF provides essential instructions for requesting leave under the Family and Medical Leave Act (FMLA). It includes details on eligibility, necessary documentation, and frequently asked questions to guide employees. A must-read for those needing to navigate their leave requests effectively.
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How do I fill this out?
To fill out the FMLA leave request, start by accessing the Workday platform. Carefully follow the prompts to enter necessary details about your leave. Ensure that you have all required documentation ready for submission.

How to fill out the Family and Medical Leave Act Instructions PDF?
1
Access the Workday platform and navigate to 'Time Off and Leave Application'.
2
Click 'Request Leave of Absence' and fill in your leave dates.
3
Select the leave type as 'FMLA' and specify the type of leave needed.
4
Submit your request and await the notification email from Workday.
5
Provide any required medical documentation to the Leave Administrators.
Who needs the Family and Medical Leave Act Instructions PDF?
1
Employees seeking to take leave for personal health issues.
2
Parents needing time off for the birth or adoption of a child.
3
Individuals caring for family members with serious health conditions.
4
Employees wanting to take intermittent leave for scheduled medical treatments.
5
Servicemembers' family members requiring extended leave during deployment.
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What are the instructions for submitting this form?
To submit this FMLA leave request form, ensure you have completed all sections accurately. You can send the document via fax at (215) 405-2929 or email it to FMLA@hr.upenn.edu for processing. Remember that no paperwork will be accepted in person or via standard mail; prompt electronic submission is essential.
What are the important dates for this form in 2024 and 2025?
Key dates regarding FMLA requests vary, but generally, employees should prepare to notify their employer at least 30 days in advance of any planned leave. For spontaneous requests, it's essential to inform the employer as soon as possible. Always check for specific deadlines related to your circumstances.

What is the purpose of this form?
This form serves as a crucial tool for employees seeking to understand and apply for their rights under the Family and Medical Leave Act. It outlines the necessary steps, eligibility requirements, and documentation needed to ensure compliance. Proper use of this form can help facilitate a smooth leave process for personal or family-related health issues.

Tell me about this form and its components and fields line-by-line.

- 1. Leave Dates: Specifies the start and estimated end date of the leave.
- 2. Leave Type: Indicates the type of leave being requested, such as FMLA.
- 3. Employee Information: Includes the employee's name, job title, and contact information.
- 4. Medical Documentation: Section for submitting any required medical certificates or forms.
- 5. Signature: Area for the employee to sign, confirming the accuracy of the information provided.
What happens if I fail to submit this form?
Failing to submit the FMLA leave request form could lead to a denial of your leave and potential job-related consequences. It's crucial to submit the form on time and ensure all necessary information is complete.
- Job Security: Not submitting your leave request could jeopardize your job position.
- Loss of Benefits: Failure to request leave may result in losing certain employee benefits.
- Legal Compliance: Not following the FMLA submission process risks non-compliance.
How do I know when to use this form?

- 1. Personal Health Issues: Employees experiencing serious health conditions should utilize this form.
- 2. Family Care: If taking leave to care for a family member, this form is necessary.
- 3. Maternity/Paternity Leave: Use this form when taking leave for the birth or adoption of a child.
Frequently Asked Questions
How do I access the FMLA leave request form?
You can find the form on our website under the documents section.
What information do I need to submit?
Make sure to include your leave dates, type of leave, and any necessary medical documentation.
Can I edit the PDF before submitting?
Yes, our platform allows you to edit the form to fit your personal needs.
How do I check my leave application status?
Send an email to FMLA@hr.upenn.edu for updates on your application.
Is there a specific deadline for submitting requests?
Generally, you should submit your request as soon as possible, ideally 30 days in advance.
What if I have trouble accessing the PDF?
Contact our support team for assistance with access issues.
Are family members covered under FMLA?
Yes, family members such as spouses, children, or parents with qualifying conditions are covered.
What is the maximum duration for FMLA leave?
Eligible employees can take up to 12 weeks of unpaid leave in a 12-month period.
Can I take intermittent leave?
Yes, if medically necessary, you may take leave intermittently.
What happens after I submit my request?
You will receive an email confirmation and instructions on the next steps.
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