United States Department Of Labor FMLA (Family & Medical Leave)
FMLA Application Forms
Please use these forms for applying for FMLA, rather than the carrier's forms. Download the form you need and print it out.
- Employee’s Serious Health Condition (WH-380-E)
- Family Member’s Serious Health Condition (WH-380-F)
- Notice of Eligibility and Rights & Responsibilities (WH-381)
- Designation Notice (WH-382)
- Certification of Qualifying Exigency For Military Family Leave (WH-384)
- Certification for Serious Injury or Illness of Current Servicemember -- for Military Family Leave (WH-385)
- Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave (WH-385-V)
- Fact Sheet #28: The Family and Medical Leave Act (Revised 2012)
Section 105 of the FMLA and section 825.220 of the FMLA regulations prohibit the following actions:
An employer is prohibited from interfering with, restraining, or denying the exercise of, or the attempt to exercise, any FMLA right.
An employer is prohibited from discriminating or retaliating against an employee or prospective employee for having exercised or attempted to exercise any FMLA right.
An employer is prohibited from discharging or in any other way discriminating against any person, whether or not an employee, for opposing or complaining about any unlawful practice under the FMLA.
All persons, whether or not employers, are prohibited from discharging or in any other way discriminating against any person, whether or not an employee, because that person has —
Filed any charge, has instituted, or caused to be instituted, any proceeding under or related to the FMLA;
Given, or is about to give, any information in connection with an inquiry or proceeding relating to any right under the FMLA; or
Testified, or is about to testify, in any inquiry or proceeding relating to a right under the FMLA.
Examples of prohibited conduct include:
- Refusing to authorize FMLA leave for an eligible employee,
- Discouraging an employee from using FMLA leave,
- Manipulating an employee’s work hours to avoid responsibilities under the FMLA,
- Using an employee’s request for or use of FMLA leave as a negative factor in employment actions, such as hiring, promotions, or disciplinary actions, or,
- Counting FMLA leave under “no fault” attendance policies.