FMLA Employee Leave Request Form

Submit this leave request form to your supervisor at least 30 days before the leave. When submission of the request 30 days in advance is not practicable, submit the request as early as is possible. 

In most cases, it should be practicable to provide notice of the need for leave either the same day as the need for leave becomes known, or the next business day. The employer reserves the right to delay or deny leave for failure to give appropriate notice when such delay/denial would be permitted under federal or state law.