Updated 06-19-18
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)
Thank you.
Section 105 of the FMLA and section 825.220 of the FMLA regulations prohibit the following actions:
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An employer is prohibited from interfering with, restraining, or denying the exercise of, or the attempt to exercise, any FMLA right.
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An employer is prohibited from discriminating or retaliating against an employee or prospective employee for having exercised or attempted to exercise any FMLA right.
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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.
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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 —
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Filed any charge, has instituted, or caused to be instituted, any proceeding under or related to the FMLA;
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Given, or is about to give, any information in connection with an inquiry or proceeding relating to any right under the FMLA; or
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Testified, or is about to testify, in any inquiry or proceeding relating to a right under the FMLA.
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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.